Provider Demographics
NPI:1902219959
Name:CASIMIR, JOEL JAVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JAVAN
Last Name:CASIMIR
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 1:4730 WOODSORREL CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1424
Mailing Address - Country:US
Mailing Address - Phone:816-833-9815
Mailing Address - Fax:
Practice Address - Street 1:1407 W 29TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1269
Practice Address - Country:US
Practice Address - Phone:816-833-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-07
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140176501223G0001X
CO002048521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice