Provider Demographics
NPI:1518564400
Name:JOSEPHS, DEVANTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEVANTE
Middle Name:
Last Name:JOSEPHS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CROSSROADS LN APT 1205
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-3011
Mailing Address - Country:US
Mailing Address - Phone:646-305-2709
Mailing Address - Fax:
Practice Address - Street 1:3380 S DYE RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1008
Practice Address - Country:US
Practice Address - Phone:810-732-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600959122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist