Provider Demographics
NPI:1063501856
Name:DAMESEK, JOSHUA JON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:JON
Last Name:DAMESEK
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 1:1618 EAST MOREHEAD STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207
Mailing Address - Country:US
Mailing Address - Phone:704-377-8677
Mailing Address - Fax:704-377-1416
Practice Address - Street 1:1618 EAST MOREHEAD STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-377-8677
Practice Address - Fax:704-377-1416
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC7123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist