Jyothish Joseph, DMD
Individual provider Active NPI Dentist · Oglesby, IL
NPI 1669825196 · NPPES record last updated Jul 20, 2016
Key facts
- NPI
- 1669825196
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019030667 (IL)
- Practice address
- 540 W Walnut St
Oglesby, IL 61348-1400 - Phone
- (815) 883-3162
- Fax
- (815) 883-7062
- NPI assigned
- Jul 20, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019030667 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Professionals of Illinois, P.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019030667 | IL | Yes |
Addresses
Primary practice location
540 W Walnut St
Oglesby, IL 61348-1400
Mailing address
540 W Walnut St
Oglesby, IL 61348-1400
Phone (815) 883-3162
Other providers in Oglesby, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 20, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.