Provider Demographics
NPI:1124107560
Name:MROZ, JOSEPH DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DANIEL
Last Name:MROZ
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 1:8059 WATSON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5304
Mailing Address - Country:US
Mailing Address - Phone:314-962-2747
Mailing Address - Fax:314-962-8306
Practice Address - Street 1:8059 WATSON RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-5304
Practice Address - Country:US
Practice Address - Phone:314-962-2747
Practice Address - Fax:314-962-8306
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0125291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice