Provider Demographics
NPI:1801008719
Name:SERVOSS, JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:SERVOSS
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:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-0910
Mailing Address - Country:US
Mailing Address - Phone:973-670-0754
Mailing Address - Fax:
Practice Address - Street 1:195 S MAPLE AVE
Practice Address - Street 2:PEDIATRIC DENTAL ASSOCIATES
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-652-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ98711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics