Provider Demographics
NPI:1538689799
Name:MINI JOSEPH DDS PLLC
Entity type:Organization
Organization Name:MINI JOSEPH DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-307-4671
Mailing Address - Street 1:506 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-6367
Mailing Address - Country:US
Mailing Address - Phone:972-878-3984
Mailing Address - Fax:
Practice Address - Street 1:2977 SOUTH PRECINCT LINE ROAD
Practice Address - Street 2:SUITE 213
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76118-7611
Practice Address - Country:US
Practice Address - Phone:817-595-9600
Practice Address - Fax:817-595-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25154261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental