Provider Demographics
NPI:1417236498
Name:WOOLLEY, JOSHUA DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DANIEL
Last Name:WOOLLEY
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 1:4875 SUMMIT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-7936
Mailing Address - Country:US
Mailing Address - Phone:775-322-2061
Mailing Address - Fax:775-322-2065
Practice Address - Street 1:4875 SUMMIT RIDGE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-7936
Practice Address - Country:US
Practice Address - Phone:775-322-2061
Practice Address - Fax:775-322-2065
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice