Provider Demographics
NPI:1679564173
Name:DORSEY, JOSEPH MILTON JR (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MILTON
Last Name:DORSEY
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 GRANDVIEW PLAZA SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6105
Mailing Address - Country:US
Mailing Address - Phone:314-830-2946
Mailing Address - Fax:314-830-4194
Practice Address - Street 1:14 GRANDVIEW PLAZA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6105
Practice Address - Country:US
Practice Address - Phone:314-830-2946
Practice Address - Fax:314-830-4194
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO118571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics