Provider Demographics
NPI:1790962645
Name:SHURTLEFF, JOSEPH L (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:SHURTLEFF
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 1:912 ROBESON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5614
Mailing Address - Country:US
Mailing Address - Phone:910-485-6136
Mailing Address - Fax:914-485-6302
Practice Address - Street 1:912 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5614
Practice Address - Country:US
Practice Address - Phone:910-485-6136
Practice Address - Fax:919-485-6302
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97602OtherBSBC