Provider Demographics
NPI:1588746770
Name:MIR, JOSEPH (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MIR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MUJTABA
Other - Middle Name:ZUBAIR
Other - Last Name:BHAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:956 TOPSY LN
Practice Address - Street 2:STE. 103
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-8447
Practice Address - Country:US
Practice Address - Phone:775-884-4888
Practice Address - Fax:775-267-4288
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV478461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1588746770Medicaid