Provider Demographics
NPI:1518086644
Name:JOSEPH, CRESSIDA LG (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRESSIDA
Middle Name:LG
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 OLDFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1267
Mailing Address - Country:US
Mailing Address - Phone:508-230-0292
Mailing Address - Fax:
Practice Address - Street 1:1016 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-2808
Practice Address - Country:US
Practice Address - Phone:617-282-2146
Practice Address - Fax:617-282-2526
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA182361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice