Provider Demographics
NPI:1255593992
Name:WAREHAM, JOSEPH PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PAUL
Last Name:WAREHAM
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 1:13431 FISHHAWK BLVD
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-3833
Mailing Address - Country:US
Mailing Address - Phone:813-438-5925
Mailing Address - Fax:
Practice Address - Street 1:13431 FISHHAWK BLVD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3833
Practice Address - Country:US
Practice Address - Phone:813-438-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist