Provider Demographics
NPI:1285742270
Name:DR. JOSEPH M. DUDA
Entity type:Organization
Organization Name:DR. JOSEPH M. DUDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:304-255-1411
Mailing Address - Street 1:150 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6761
Mailing Address - Country:US
Mailing Address - Phone:304-255-1411
Mailing Address - Fax:304-255-5111
Practice Address - Street 1:150 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6761
Practice Address - Country:US
Practice Address - Phone:304-255-1411
Practice Address - Fax:304-255-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3202261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0138072000Medicaid
WV0138072000Medicaid
U29854Medicare UPIN