Provider Demographics
NPI:1881132710
Name:HEADLEY, JOSHUA RAY (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RAY
Last Name:HEADLEY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 EDGEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5343
Mailing Address - Country:US
Mailing Address - Phone:205-908-0193
Mailing Address - Fax:
Practice Address - Street 1:1700 6TH AVE N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4849
Practice Address - Country:US
Practice Address - Phone:205-434-2031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-12
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006431-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice