Healthcare Provider Details

I. General information

NPI: 1992018048
Provider Name (Legal Business Name): JOSEPH ALLRED DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E 3RD AVE S
CAVALIER ND
58220-4023
US

IV. Provider business mailing address

PO BOX 635
CAVALIER ND
58220-0635
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8777
  • Fax:
Mailing address:
  • Phone: 701-265-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3350
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number27291
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD008871
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2299
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: