Dr. Jossen P Gastelum, DMD
Dentist, General Practice in Marana, AZ. Individual provider (NPI-1).
NPI number1730798331
StatusActive
Last updated in NPPESOct 31, 2020
Details
- NPI
- 1730798331
- Entity type
- Individual (NPI-1)
- Name
- Dr. Jossen P Gastelum
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 29, 2020
- Certification date
- Oct 31, 2020
- Last updated
- Oct 31, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | D010862 | AZ | Yes |
| 1223G0001X | Dentist, General Practice | 10479 | KY |
Practice location
12090 N Thornydale Rd Ste 106Marana, AZ 85658-4779
Phone 520-616-4610
Mailing address
12090 N Thornydale Rd Ste 106Marana, AZ 85658-4779
Phone 520-616-4610
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