Provider Demographics
NPI:1487216768
Name:PFAB, JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:PFAB
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 1:1885 BOYER WAY
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7634
Mailing Address - Country:US
Mailing Address - Phone:804-397-5156
Mailing Address - Fax:
Practice Address - Street 1:14912 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-2535
Practice Address - Country:US
Practice Address - Phone:804-639-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014166241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice