Provider Demographics
NPI:1962692988
Name:WAYNE J JOSEPH, D.D.S.,MS,PC
Entity type:Organization
Organization Name:WAYNE J JOSEPH, D.D.S.,MS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-521-5800
Mailing Address - Street 1:10751 WHITTIER ST
Mailing Address - Street 2:19010 W TEN MILE RD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-1754
Mailing Address - Country:US
Mailing Address - Phone:313-521-5800
Mailing Address - Fax:734-721-4746
Practice Address - Street 1:10751 WHITTIER ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-1754
Practice Address - Country:US
Practice Address - Phone:313-521-5800
Practice Address - Fax:734-721-4746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI123481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty