Provider Demographics
NPI:1336276187
Name:ABLOG, JOYCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:ABLOG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4829 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-6585
Mailing Address - Country:US
Mailing Address - Phone:812-422-1135
Mailing Address - Fax:812-422-1978
Practice Address - Street 1:4829 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6585
Practice Address - Country:US
Practice Address - Phone:812-422-1135
Practice Address - Fax:812-422-1978
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice