Provider Demographics
NPI:1619639101
Name:HABIB, JOSEPH (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:HABIB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 BAY HARBOR DR APT 102
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3401
Mailing Address - Country:US
Mailing Address - Phone:760-812-3526
Mailing Address - Fax:
Practice Address - Street 1:32919 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3121
Practice Address - Country:US
Practice Address - Phone:727-787-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN264951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice