Provider Demographics
NPI:1164413233
Name:JOSEPH, GEORGE (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 LEONARD LN
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-8346
Mailing Address - Country:US
Mailing Address - Phone:630-323-7472
Mailing Address - Fax:
Practice Address - Street 1:3171 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-1809
Practice Address - Country:US
Practice Address - Phone:773-533-2333
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice