Individual
DR. JOSEPH LEO WALDVOGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 686-4151
Mailing address
1500 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3318
(573) 686-4151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019-016659
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12
DENTAL PROVIDER
IL
Enumeration date
09/28/2007
Last updated
09/17/2015
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