Provider Demographics
NPI:1740202837
Name:DUFRESNE, JOSEPH VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VICTOR
Last Name:DUFRESNE
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 1:80 LODGE POLE TRL
Mailing Address - Street 2:
Mailing Address - City:MINERAL BLUFF
Mailing Address - State:GA
Mailing Address - Zip Code:30559-3244
Mailing Address - Country:US
Mailing Address - Phone:404-310-2456
Mailing Address - Fax:
Practice Address - Street 1:6612 EXCHANGE PL
Practice Address - Street 2:SUITE B
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2358
Practice Address - Country:US
Practice Address - Phone:770-968-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice