Provider Demographics
NPI:1992050942
Name:JANASZAK, JOSEPH ERIC
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ERIC
Last Name:JANASZAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 BRIDGEPORT WAY W STE E
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4331
Mailing Address - Country:US
Mailing Address - Phone:253-565-0404
Mailing Address - Fax:253-565-0406
Practice Address - Street 1:4115 BRIDGEPORT WAY W STE E
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4331
Practice Address - Country:US
Practice Address - Phone:253-565-0404
Practice Address - Fax:253-565-0406
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58362122300000X
WADE00006667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist