Provider Demographics
NPI:1881053247
Name:JOSEPH THAYIL DMD PA
Entity type:Organization
Organization Name:JOSEPH THAYIL DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:THAYIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-655-6368
Mailing Address - Street 1:2700 NE 14TH STREET CSWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3561
Mailing Address - Country:US
Mailing Address - Phone:954-941-2412
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-14
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty