Provider Demographics
NPI:1689823379
Name:JAHIMIAK, JOEL
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:JAHIMIAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186
Mailing Address - Country:US
Mailing Address - Phone:262-549-6850
Mailing Address - Fax:
Practice Address - Street 1:419 E BROADWAY
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5082
Practice Address - Country:US
Practice Address - Phone:262-549-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5851-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist