Provider Demographics
NPI:1346291580
Name:SHLEWEET, JOSEPH K (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:K
Last Name:SHLEWEET
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 1:526 S CHOCTAW ST
Mailing Address - Street 2:SUITE B & C
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4807
Mailing Address - Country:US
Mailing Address - Phone:662-627-3633
Mailing Address - Fax:662-627-5655
Practice Address - Street 1:526 S CHOCTAW ST
Practice Address - Street 2:SUITE B & C
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4807
Practice Address - Country:US
Practice Address - Phone:662-627-3633
Practice Address - Fax:662-627-5655
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3359051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07587317Medicaid