Provider Demographics
NPI:1780681098
Name:DOCTORA, JOSEPH SERAFIN (DDS, MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SERAFIN
Last Name:DOCTORA
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 S LOWRY ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3415
Mailing Address - Country:US
Mailing Address - Phone:615-220-5525
Mailing Address - Fax:615-220-5556
Practice Address - Street 1:366 S LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3415
Practice Address - Country:US
Practice Address - Phone:615-220-5525
Practice Address - Fax:615-220-5556
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS72681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU75813Medicare UPIN
TN3226329Medicare ID - Type Unspecified