Provider Demographics
NPI:1336157395
Name:JOSEPH, MICHAEL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:JOSEPH
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 1:1144 MARKET ST
Mailing Address - Street 2:STE 505
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2941
Mailing Address - Country:US
Mailing Address - Phone:304-233-2242
Mailing Address - Fax:
Practice Address - Street 1:1144 MARKET ST
Practice Address - Street 2:STE 505
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2941
Practice Address - Country:US
Practice Address - Phone:304-233-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135377000Medicaid
WV0135377000Medicaid