Provider Demographics
NPI:1720391402
Name:JOSHUA A. DUBOSE, D.M.D., P.C.
Entity Type:Organization
Organization Name:JOSHUA A. DUBOSE, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-267-6822
Mailing Address - Street 1:PO BOX 1214
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1214
Mailing Address - Country:US
Mailing Address - Phone:770-267-6822
Mailing Address - Fax:770-267-0928
Practice Address - Street 1:416 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2350
Practice Address - Country:US
Practice Address - Phone:770-267-6822
Practice Address - Fax:770-267-0928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA716288876BMedicaid