Provider Demographics
NPI:1669685947
Name:ICENHOWER, JOSEPH BRYAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRYAN
Last Name:ICENHOWER
Suffix:JR
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 1:1408 EGYPT RD
Mailing Address - Street 2:P.O. BOX 402
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-0402
Mailing Address - Country:US
Mailing Address - Phone:610-666-5118
Mailing Address - Fax:610-666-5088
Practice Address - Street 1:1408 EGYPT RD
Practice Address - Street 2:
Practice Address - City:OAKS
Practice Address - State:PA
Practice Address - Zip Code:19456-0402
Practice Address - Country:US
Practice Address - Phone:610-666-5118
Practice Address - Fax:610-666-5088
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-019924-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice