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Provider Information for 1184839623



DR. JOSEPH JACK WIDDISON DMD

Gender: MALE

Individual NPI: 1184839623

Calendar   Last Updated:  2015-04-06
  Certification Date: 

Details

Name Value
NPI 1184839623
Enumeration Date 2007-05-10
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1555 MAIN ST SUITE A-2
WINDSOR, CO 80550-5998
United States

Phone: 970-690-9823 | Fax:
View Map External Link
Primary Practice Address 1555 MAIN ST SUITE A-2
WINDSOR, CO 80550-5998
United States

Phone: 970-690-9823 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist CO 9379
No 122300000X - Dentist TX 26396