Provider Demographics
NPI:1275703522
Name:MASSEY, JOE C (DENTIST)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:C
Last Name:MASSEY
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4512
Mailing Address - Country:US
Mailing Address - Phone:912-264-6255
Mailing Address - Fax:912-264-2112
Practice Address - Street 1:1108 1ST ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4512
Practice Address - Country:US
Practice Address - Phone:912-264-6255
Practice Address - Fax:912-264-2112
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice