Provider Demographics
NPI:1598073538
Name:JOSEPH, PREETHI P (DDS)
Entity Type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:P
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 MARINER'S ISLAND BLVD.
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:650-577-1988
Mailing Address - Fax:650-577-0835
Practice Address - Street 1:675 MARINER'S ISLAND BLVD.
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:650-577-1988
Practice Address - Fax:650-577-0835
Is Sole Proprietor?:No
Enumeration Date:2010-09-23
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist