Provider Demographics
NPI:1225552698
Name:JOSEPH, DERRICK ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:ANTONIO
Last Name:JOSEPH
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 1:7021 HIGHVIEW TER APT 302
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-4045
Mailing Address - Country:US
Mailing Address - Phone:229-740-3890
Mailing Address - Fax:
Practice Address - Street 1:2803 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-7007
Practice Address - Country:US
Practice Address - Phone:717-819-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist