Provider Demographics
NPI:1598816647
Name:BURNELL, JOSPEH DANIEL (RDH)
Entity Type:Individual
Prefix:MR
First Name:JOSPEH
Middle Name:DANIEL
Last Name:BURNELL
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CLEARWATER DR UNIT 67
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1359
Mailing Address - Country:US
Mailing Address - Phone:207-712-8483
Mailing Address - Fax:
Practice Address - Street 1:171 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1531
Practice Address - Country:US
Practice Address - Phone:207-443-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3059124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist