Provider Demographics
NPI:1124221106
Name:JOSEPHSEN, ALFRED P JR (DMD, FAGD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:P
Last Name:JOSEPHSEN
Suffix:JR
Gender:M
Credentials:DMD, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-8200
Mailing Address - Country:US
Mailing Address - Phone:973-228-0076
Mailing Address - Fax:
Practice Address - Street 1:31 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-8200
Practice Address - Country:US
Practice Address - Phone:973-228-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ136191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice