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NPI Code Detail

MEDICARE: PHILIPKJOSEPHSLLC

MEDICARE: PHILIPKJOSEPHSLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodontics

General Provider Information

NPI Number : 1396344354
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHILIPKJOSEPHSLLC
Provider Business Mailing Address
First Line : 161 MONTEREY BAY DR
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8438
Country : US
Telephone Number : 561-414-9145
Fax Number :
Provider Business Practice Location Address
First Line : 161 MONTEREY BAY DR
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33426-8438
Country : US
Telephone Number : 561-414-9145
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : PHILIP JOSEPHS
Credential :
Telephone Number : 561-414-9145
Provider Enumeration Date : 10/21/2020
Last Update Date : 10/21/2020

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Directions to “PHILIPKJOSEPHSLLC ” Practice Location

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