Provider Demographics
NPI:1114062767
Name:JOSEPH R. NEMETH, DDS, PC
Entity Type:Organization
Organization Name:JOSEPH R. NEMETH, DDS, PC
Other - Org Name:MICHIGAN 3-D DENTAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:NEMETH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-357-3100
Mailing Address - Street 1:29829 TELEGRAPH RD
Mailing Address - Street 2:STE 111
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-7655
Mailing Address - Country:US
Mailing Address - Phone:248-357-3100
Mailing Address - Fax:248-357-1626
Practice Address - Street 1:29829 TELEGRAPH RD
Practice Address - Street 2:STE 111
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-7655
Practice Address - Country:US
Practice Address - Phone:248-357-3100
Practice Address - Fax:248-357-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010082741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5637558OtherBLUE CROSS BLUE SHIELD
MI5532043OtherAETNA