Provider Demographics
NPI:1487748216
Name:TAM, JOSEPH CHOCK JR (DDS)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHOCK
Last Name:TAM
Suffix:JR
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 1:200 SUDDERTH DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345
Mailing Address - Country:US
Mailing Address - Phone:505-257-5179
Mailing Address - Fax:505-257-5170
Practice Address - Street 1:200 SUDDERTH DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345
Practice Address - Country:US
Practice Address - Phone:505-257-5179
Practice Address - Fax:505-257-5170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD1170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist