Provider Demographics
NPI:1679690176
Name:JOSEPH, JOE R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:JOSEPH
Suffix:JR
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 1:6044 PARKMEADOW LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7406
Mailing Address - Country:US
Mailing Address - Phone:614-777-8722
Mailing Address - Fax:
Practice Address - Street 1:6044 PARKMEADOW LN
Practice Address - Street 2:SUITE A
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7406
Practice Address - Country:US
Practice Address - Phone:614-777-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist