Provider Demographics
NPI:1518039684
Name:DYSON, JOSEPH LEE JR (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LEE
Last Name:DYSON
Suffix:JR
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LIBERTY HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7052
Mailing Address - Country:US
Mailing Address - Phone:410-542-7877
Mailing Address - Fax:410-542-7884
Practice Address - Street 1:4901 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7052
Practice Address - Country:US
Practice Address - Phone:410-542-7877
Practice Address - Fax:410-542-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist