Provider Demographics
NPI:1104186550
Name:JOSEPH DENTAL GROUP OF VAN WERT
Entity Type:Organization
Organization Name:JOSEPH DENTAL GROUP OF VAN WERT
Other - Org Name:WESTWOOD FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-605-5159
Mailing Address - Street 1:1142 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2449
Mailing Address - Country:US
Mailing Address - Phone:419-605-5159
Mailing Address - Fax:419-238-9193
Practice Address - Street 1:1142 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2449
Practice Address - Country:US
Practice Address - Phone:419-605-5159
Practice Address - Fax:419-238-9193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH198291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty