Provider Demographics
NPI:1134288285
Name:VAN CLEVE, JOSEPH G (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:VAN CLEVE
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 1:2252 W MAGEE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-4329
Mailing Address - Country:US
Mailing Address - Phone:520-447-5348
Mailing Address - Fax:
Practice Address - Street 1:2252 W MAGEE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-4329
Practice Address - Country:US
Practice Address - Phone:520-447-5348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ347552Medicaid