Provider Demographics
NPI:1215187240
Name:KREISS, JOEL SHELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SHELDON
Last Name:KREISS
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 1:509 LAKE OF THE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-7221
Mailing Address - Country:US
Mailing Address - Phone:941-492-3597
Mailing Address - Fax:
Practice Address - Street 1:509 LAKE OF THE WOODS DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-7221
Practice Address - Country:US
Practice Address - Phone:941-492-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist