Individual
JAN JOSEPHSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1511
(602) 263-1637
Mailing address
PO BOX 310001-069, PASADENA, CA 91110-0698
(602) 263-1511
(602) 263-1637
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
001433
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0471626
BCBS
AZ
05
—
471566
—
AZ
Enumeration date
09/03/2006
Last updated
07/08/2007
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