Provider Demographics
NPI:1811626708
Name:JOSEPHSON, DALLIN M (DDS)
Entity Type:Individual
Prefix:
First Name:DALLIN
Middle Name:M
Last Name:JOSEPHSON
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 1:2108 HOLLOW LOG DR
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:MO
Mailing Address - Zip Code:64060-6200
Mailing Address - Country:US
Mailing Address - Phone:636-577-2223
Mailing Address - Fax:
Practice Address - Street 1:2011 W JESSE JAMES RD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1853
Practice Address - Country:US
Practice Address - Phone:816-630-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220187961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice