Provider Demographics
NPI:1629119540
Name:LARGEMAN, JOSEPH HERMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:HERMAN
Last Name:LARGEMAN
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 1:13318 HWY 27
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-5659
Mailing Address - Country:US
Mailing Address - Phone:706-628-5685
Mailing Address - Fax:
Practice Address - Street 1:3830 ROSEMONT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5659
Practice Address - Country:US
Practice Address - Phone:706-322-6581
Practice Address - Fax:706-571-8744
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0116431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice