Provider Demographics
NPI:1659457489
Name:JOSEPH, PHILIP MOSES
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:MOSES
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PHILIP
Other - Middle Name:MOSES
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D M D
Mailing Address - Street 1:116 ATRIUM WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6301
Mailing Address - Country:US
Mailing Address - Phone:803-699-2600
Mailing Address - Fax:803-699-1731
Practice Address - Street 1:116 ATRIUM WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6301
Practice Address - Country:US
Practice Address - Phone:803-699-2600
Practice Address - Fax:803-699-1731
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics