Provider Demographics
NPI:1851436703
Name:GONDREZ, JOSEPH MARTIN (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARTIN
Last Name:GONDREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 JOHNS HOPKINS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7227
Mailing Address - Country:US
Mailing Address - Phone:252-752-6188
Mailing Address - Fax:252-752-5728
Practice Address - Street 1:1025 JOHNS HOPKINS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7227
Practice Address - Country:US
Practice Address - Phone:252-752-6188
Practice Address - Fax:252-752-5728
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902AHMedicaid
NC902AHOtherBCBS