Provider Demographics
NPI:1639301286
Name:THAYIL, JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:THAYIL
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 1:17716 MAISONS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3801
Mailing Address - Country:US
Mailing Address - Phone:954-655-6368
Mailing Address - Fax:
Practice Address - Street 1:2700 NE 14TH STREET CSWY
Practice Address - Street 2:SUITE 105
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3561
Practice Address - Country:US
Practice Address - Phone:954-941-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist