Provider Demographics
NPI:1710079611
Name:MASSAD, JOSEPH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:MASSAD
Suffix:
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 1:3314 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-3824
Mailing Address - Country:US
Mailing Address - Phone:918-749-5600
Mailing Address - Fax:918-742-6666
Practice Address - Street 1:3314 E 11TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-3824
Practice Address - Country:US
Practice Address - Phone:918-749-5600
Practice Address - Fax:918-742-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice