Individual
DR. MARK R JOSEPHS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
16260 AIRLINE HWY, SUITE A, PRAIRIEVILLE, LA 70769-4272
(225) 744-2660
(225) 744-2666
Mailing address
16260 AIRLINE HWY, SUITE A, PRAIRIEVILLE, LA 70769-4272
(225) 744-2660
(225) 744-2666
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6296
LA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
2901019754
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1992051107
GROUP NPI
LA
Enumeration date
07/01/2008
Last updated
07/24/2014
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