Provider Demographics
NPI:1528874534
Name:JOSH BROTHERS DENTAL PLLC
Entity type:Organization
Organization Name:JOSH BROTHERS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-301-7663
Mailing Address - Street 1:317 W 3RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1465
Mailing Address - Country:US
Mailing Address - Phone:719-384-8703
Mailing Address - Fax:719-384-2398
Practice Address - Street 1:317 W 3RD ST STE 101
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1465
Practice Address - Country:US
Practice Address - Phone:719-384-8703
Practice Address - Fax:719-384-2398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty