Provider Demographics
NPI:1740305614
Name:WETHERHOLD, JOSEPH H (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:H
Last Name:WETHERHOLD
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 1:348 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-7016
Mailing Address - Country:US
Mailing Address - Phone:207-865-1900
Mailing Address - Fax:207-865-1922
Practice Address - Street 1:348 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7016
Practice Address - Country:US
Practice Address - Phone:207-865-1900
Practice Address - Fax:207-865-1922
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME37411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119860000Medicaid
1891829735OtherCORP. NPI
1891829735OtherCORP. NPI