Provider Demographics
NPI:1699960864
Name:PACKER, JOSEPH L (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:PACKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28081 EDELWEISS CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7006
Mailing Address - Country:US
Mailing Address - Phone:702-292-0759
Mailing Address - Fax:
Practice Address - Street 1:15825 LAGUNA CANYON RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2125
Practice Address - Country:US
Practice Address - Phone:949-789-8989
Practice Address - Fax:949-453-0970
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588871223E0200X
NV55601223E0200X
UT6657777-99221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics