Provider Demographics
NPI:1437201449
Name:JOSEPHS, EDWIN (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:JOSEPHS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5657 SUTTERMILL DR
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-9590
Mailing Address - Country:US
Mailing Address - Phone:213-820-2153
Mailing Address - Fax:
Practice Address - Street 1:1213 COFFEE RD
Practice Address - Street 2:STE. J
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4229
Practice Address - Country:US
Practice Address - Phone:209-529-6995
Practice Address - Fax:209-529-1810
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice