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General NPI Number Information
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NPI Number | 1053707240
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Entity Type | Organization
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Legal Business Name | JOSEPH DENTAL OF SOUTH SHORE LLC
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Dates
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Enumeration Date | 04/14/2015
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 126 BIGGS LN
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City | SOUTH SHORE
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State | KY
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Zip | 41175-7847
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Country | US
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Telephone | 606-932-3181
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Fax |
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Provider Business Mailing Address
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Address Line | 126 BIGGS LN
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City | SOUTH SHORE
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State | KY
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Zip | 41175-7847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOE ROBERT JOSEPH JR.
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Credential | DDS
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Telephone | 614-777-8722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19829
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License Number State | OH
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