Joseph W Provo III, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

16452 Issued in TX

Practice address

1460 Ih 10 East
Suite a
Beaumont, TX 77703

Phone

(409) 833-0261

Fax

(409) 833-0543

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487874400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 IH 10 EAST",
            "address_2": "SUITE A",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "77703",
            "telephone_number": "409-833-0261",
            "fax_number": "409-833-0543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 IH 10 EAST",
            "address_2": "SUITE A",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "77703",
            "telephone_number": "409-833-0261",
            "fax_number": "409-833-0543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVO",
        "first_name": "JOSEPH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "16452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corey Lynn Proenza
• Pronto Medical Services
• Prosthetic Solution Centers of America, LLC
• Provision Imaging of Beaumont
• Provisionam
• Brazhona Prudhomme
• Stacy Lynn Pruitt, RD, LD
• Gita Chetty Pulley, O. D.
• Pulse Homecare, LTD.
• Nestor Cagol Punay, M.D.

• Dentist in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.