Provider Demographics
NPI:1003887555
Name:IRMEN, JOSEPH M (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:IRMEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2310
Mailing Address - Country:US
Mailing Address - Phone:989-631-0840
Mailing Address - Fax:989-631-5350
Practice Address - Street 1:4710 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2310
Practice Address - Country:US
Practice Address - Phone:989-631-0840
Practice Address - Fax:989-631-5350
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2709818Medicaid