Provider Demographics
NPI:1104413822
Name:M. JOE DENTAL CORPORATION
Entity type:Organization
Organization Name:M. JOE DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRADFORD
Authorized Official - Last Name:JOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-738-0888
Mailing Address - Street 1:333 W MAUDE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4367
Mailing Address - Country:US
Mailing Address - Phone:408-736-0888
Mailing Address - Fax:408-736-7973
Practice Address - Street 1:333 W MAUDE AVE STE 101
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4367
Practice Address - Country:US
Practice Address - Phone:408-736-0888
Practice Address - Fax:408-736-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty