Provider Demographics
NPI:1609223023
Name:FARKASH, JOSEPH MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARTIN
Last Name:FARKASH
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 1:28442 DRIVER AVE
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2616
Mailing Address - Country:US
Mailing Address - Phone:818-963-0696
Mailing Address - Fax:
Practice Address - Street 1:4913 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9632
Practice Address - Country:US
Practice Address - Phone:530-556-4810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223281223G0001X
CADDS1052061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADDS105206OtherDENTAL BOARD OF CALIFORNIA