Provider Demographics
NPI:1730486630
Name:PIERSE, JOSEPH EDWARD (DMD, MA)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:PIERSE
Suffix:
Gender:M
Credentials:DMD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 S VAL VISTA DR STE 164
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1638
Mailing Address - Country:US
Mailing Address - Phone:480-855-3223
Mailing Address - Fax:480-855-1229
Practice Address - Street 1:2680 S VAL VISTA DR STE 164
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1638
Practice Address - Country:US
Practice Address - Phone:480-855-3223
Practice Address - Fax:480-855-1229
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-12
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0095621223S0112X, 1223P0700X
PADS0398801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA355733Medicare PIN