Provider Demographics
NPI:1124449277
Name:ATKINS, JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:ATKINS
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 1:221 STATE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1173
Mailing Address - Country:US
Mailing Address - Phone:304-369-1695
Mailing Address - Fax:304-369-1706
Practice Address - Street 1:221 STATE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1173
Practice Address - Country:US
Practice Address - Phone:304-369-1695
Practice Address - Fax:304-369-1706
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0133573000Medicaid