Provider Demographics
NPI:1962597591
Name:TUAZON, JOSEPH C (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:TUAZON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39242 DEQUINDRE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-1767
Mailing Address - Country:US
Mailing Address - Phone:248-680-1680
Mailing Address - Fax:586-795-5910
Practice Address - Street 1:39242 DEQUINDRE RD STE 107
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-1767
Practice Address - Country:US
Practice Address - Phone:248-680-1680
Practice Address - Fax:586-795-5910
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI173631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4162123Medicaid