Provider Demographics
NPI:1376112045
Name:HESS, JOSEPH RANDOLPH (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RANDOLPH
Last Name:HESS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5337
Mailing Address - Country:US
Mailing Address - Phone:580-772-7747
Mailing Address - Fax:
Practice Address - Street 1:519 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5337
Practice Address - Country:US
Practice Address - Phone:580-772-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK74861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice