Provider Demographics
NPI:1184773053
Name:DUBOSE, JOSHUA ALVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:ALVIN
Last Name:DUBOSE
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 1:250 RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NEWBORN
Mailing Address - State:GA
Mailing Address - Zip Code:30056-2852
Mailing Address - Country:US
Mailing Address - Phone:706-468-7022
Mailing Address - Fax:770-267-0928
Practice Address - Street 1:416 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2350
Practice Address - Country:US
Practice Address - Phone:770-267-6822
Practice Address - Fax:770-267-0928
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice