Provider Demographics
NPI:1598960114
Name:DUCKSWORTH, JOSEPH W (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:DUCKSWORTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:975 PEACHTREE PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6828
Mailing Address - Country:US
Mailing Address - Phone:770-312-1544
Mailing Address - Fax:770-818-5894
Practice Address - Street 1:975 PEACHTREE PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6828
Practice Address - Country:US
Practice Address - Phone:770-312-1544
Practice Address - Fax:770-818-5894
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0134801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery