Provider Demographics
NPI:1770522625
Name:YOSEPH, PAULINE A (D,D,S)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:A
Last Name:YOSEPH
Suffix:
Gender:F
Credentials:D,D,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 DAVIS ST
Practice Address - Street 2:SUITE 460
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4431
Practice Address - Country:US
Practice Address - Phone:847-332-2226
Practice Address - Fax:847-332-1683
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice