Provider Demographics
NPI:1639149156
Name:JOSEPH, TRACEY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:H
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 FLATBUSH AVE
Mailing Address - Street 2:SUITE A104
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3276
Mailing Address - Country:US
Mailing Address - Phone:718-377-1319
Mailing Address - Fax:718-377-1302
Practice Address - Street 1:1655 FLATBUSH AVE
Practice Address - Street 2:SUITE A104
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3276
Practice Address - Country:US
Practice Address - Phone:718-377-1319
Practice Address - Fax:718-377-1302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1687857OtherUNITED CONCORDIA
NY01995862Medicaid
NY0013156OtherDORAL DENTAL NY INC