Provider Demographics
NPI:1245613439
Name:MARDINI, JOSEPH-CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH-CHARLES
Middle Name:
Last Name:MARDINI
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 1:740 BOULEVARD MONTPELLIER
Mailing Address - Street 2:APT 1614
Mailing Address - City:MONTREAL
Mailing Address - State:QEUEBC
Mailing Address - Zip Code:H4L 5B1
Mailing Address - Country:CA
Mailing Address - Phone:240-477-9551
Mailing Address - Fax:
Practice Address - Street 1:110 HIGHWAY 61 S
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5217
Practice Address - Country:US
Practice Address - Phone:240-477-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3851-16122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist