Provider Demographics
NPI:1609919646
Name:BORDEAUX, JOSEPH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BORDEAUX
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 56TH ST NW STE 120
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-8593
Mailing Address - Country:US
Mailing Address - Phone:253-851-5262
Mailing Address - Fax:253-851-5313
Practice Address - Street 1:3519 56TH ST NW STE 120
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-8593
Practice Address - Country:US
Practice Address - Phone:253-851-5262
Practice Address - Fax:253-851-5313
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA65091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics