Provider Demographics
NPI:1821355785
Name:JOSEPH K SHLEWEET DDS, PLLC
Entity Type:Organization
Organization Name:JOSEPH K SHLEWEET DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHLEWEET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:662-627-3633
Mailing Address - Street 1:526 S CHOCTAW ST STE B&C
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4807
Mailing Address - Country:US
Mailing Address - Phone:662-627-3633
Mailing Address - Fax:662-627-5655
Practice Address - Street 1:526 S CHOCTAW ST STE B&C
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4807
Practice Address - Country:US
Practice Address - Phone:662-627-3633
Practice Address - Fax:662-627-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3359-05261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07587317Medicaid