Provider Demographics
NPI:1659308294
Name:SANSEVERE, JOSEPH J (DMD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:J
Last Name:SANSEVERE
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 1:6 SAND HILL RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-4946
Mailing Address - Country:US
Mailing Address - Phone:908-806-7060
Mailing Address - Fax:908-782-1235
Practice Address - Street 1:6 SAND HILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-4946
Practice Address - Country:US
Practice Address - Phone:908-806-7060
Practice Address - Fax:908-782-1235
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ174071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ533235Medicare ID - Type Unspecified