Provider Demographics
NPI:1578158234
Name:MEHLHAFF, JOSHUA MARK (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MARK
Last Name:MEHLHAFF
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 1:14727 BOTHELL WAY NE APT 32
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7643
Mailing Address - Country:US
Mailing Address - Phone:206-962-9336
Mailing Address - Fax:
Practice Address - Street 1:527 TUSKEGEE AIRMAN AVE
Practice Address - Street 2:
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-1920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61189856122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist