Provider Demographics
NPI:1265514004
Name:JOSE, JOEL G (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:G
Last Name:JOSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1375 CHERRY WAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8700
Mailing Address - Country:US
Mailing Address - Phone:614-428-7320
Mailing Address - Fax:614-428-7322
Practice Address - Street 1:1375 CHERRY WAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8700
Practice Address - Country:US
Practice Address - Phone:614-428-7320
Practice Address - Fax:614-428-7322
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH199541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics