Provider Demographics
NPI:1508230012
Name:DUFFY, JOSHUA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:DUFFY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 HALE ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1020
Mailing Address - Country:US
Mailing Address - Phone:864-616-9849
Mailing Address - Fax:
Practice Address - Street 1:4004 BAYBORO ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2867
Practice Address - Country:US
Practice Address - Phone:864-616-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice