Provider Demographics
NPI:1962529859
Name:NASSER, JOSEPH A (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:NASSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6719
Mailing Address - Country:US
Mailing Address - Phone:561-659-6270
Mailing Address - Fax:561-659-6512
Practice Address - Street 1:1301 S FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6719
Practice Address - Country:US
Practice Address - Phone:561-659-6270
Practice Address - Fax:561-659-6512
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00134751223G0001X
IL0190233481223G0001X
DCDEN55981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN0013475OtherSTATE OF FLORIDA LICENSE
142930157OtherADA MEMBER NUMBER
FL074659200Medicaid
IL019023348OtherILLINOIS DENT LICENSE NO.
DCDEN5598OtherDC LICENSE NUMBER
DCDEN5598OtherDC LICENSE NUMBER
DCBN3753630OtherDEA REGISTRATION NUMBER