Provider Demographics
NPI:1053833509
Name:JOSEPH, JOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 INDIAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3405
Mailing Address - Country:US
Mailing Address - Phone:502-299-6671
Mailing Address - Fax:
Practice Address - Street 1:2702 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6299
Practice Address - Country:US
Practice Address - Phone:931-614-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2017-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice