Provider Demographics
NPI:1891355202
Name:HAVIG, JOSEPH ALEXANDER (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALEXANDER
Last Name:HAVIG
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 1:40092 N THOROUGHBRED WAY
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5181
Mailing Address - Country:US
Mailing Address - Phone:480-284-1338
Mailing Address - Fax:
Practice Address - Street 1:2494 AIRLINE DR STE 100
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-5841
Practice Address - Country:US
Practice Address - Phone:318-317-7808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist