Provider Demographics
NPI:1205856861
Name:WILLARDSEN, JOESPH GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOESPH
Middle Name:GEORGE
Last Name:WILLARDSEN
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 1:35 TAPADERO LN
Mailing Address - Street 2:LANE
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-7851
Mailing Address - Country:US
Mailing Address - Phone:702-523-3030
Mailing Address - Fax:
Practice Address - Street 1:7480 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2740
Practice Address - Country:US
Practice Address - Phone:702-343-4800
Practice Address - Fax:702-433-4806
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice