Provider Demographics
NPI:1912012279
Name:MALTSBERGER, JOE FRANK (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:FRANK
Last Name:MALTSBERGER
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:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:OOLOGAH
Mailing Address - State:OK
Mailing Address - Zip Code:74053
Mailing Address - Country:US
Mailing Address - Phone:918-443-2431
Mailing Address - Fax:918-443-2438
Practice Address - Street 1:HWY 169 AND ATLAS AVE
Practice Address - Street 2:
Practice Address - City:OOLOGAH
Practice Address - State:OK
Practice Address - Zip Code:74053
Practice Address - Country:US
Practice Address - Phone:918-443-2431
Practice Address - Fax:918-443-2438
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4258122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist