Provider Demographics
NPI:1821332297
Name:JOE, MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:JOE
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 1:333 W MAUDE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4372
Mailing Address - Country:US
Mailing Address - Phone:408-736-0888
Mailing Address - Fax:
Practice Address - Street 1:333 W MAUDE AVE
Practice Address - Street 2:STE 101
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4372
Practice Address - Country:US
Practice Address - Phone:408-736-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-24
Last Update Date:2012-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist