Provider Demographics
NPI:1730200205
Name:MASTEY, JOSEPH G (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:MASTEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3166 COUNTY HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166
Mailing Address - Country:US
Mailing Address - Phone:715-526-5677
Mailing Address - Fax:
Practice Address - Street 1:401 SOUTH JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:BONDUEL
Practice Address - State:WI
Practice Address - Zip Code:54107
Practice Address - Country:US
Practice Address - Phone:715-758-2674
Practice Address - Fax:715-758-2837
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4295 - 015122300000X
IN12008925A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist