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General NPI Number Information
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NPI Number | 1124970678
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Entity Type | Organization
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Legal Business Name | JOSEPH DENTAL GROUP
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Dates
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Enumeration Date | 02/09/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 54055 COUNTY ROAD 653
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City | PAW PAW
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State | MI
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Zip | 49079-9486
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Country | US
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Telephone | 269-657-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 8923 AUSTIN CT
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City | PORTAGE
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State | MI
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Zip | 49002-6471
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Country | US
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Telephone | 207-409-7454
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA JOSEPH
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Credential | DDS
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Telephone | 269-657-3900
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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 |
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License Number State |
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