Provider Demographics
NPI:1053849943
Name:DOYLE, JOSHUA W (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:W
Last Name:DOYLE
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-0010
Mailing Address - Country:US
Mailing Address - Phone:715-339-3021
Mailing Address - Fax:
Practice Address - Street 1:915 CASEMENT CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1204
Practice Address - Country:US
Practice Address - Phone:715-748-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10015251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice