Healthcare Provider Details

I. General information

NPI: 1962186312
Provider Name (Legal Business Name): BRITTANY ANNE JOSEPH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 BIG TYLER RD STE 1
CROSS LANES WV
25313-1195
US

IV. Provider business mailing address

29 PINNACLE DR
CHARLESTON WV
25311-1351
US

V. Phone/Fax

Practice location:
  • Phone: 304-776-4541
  • Fax:
Mailing address:
  • Phone: 304-382-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4632
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: