Provider Demographics
NPI:1669642120
Name:JOSEPH, JOSEPH M (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:JOSEPH
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 1:445 ROSEWOOD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5929
Mailing Address - Country:US
Mailing Address - Phone:805-484-0405
Mailing Address - Fax:805-388-3595
Practice Address - Street 1:445 ROSEWOOD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5929
Practice Address - Country:US
Practice Address - Phone:805-484-0405
Practice Address - Fax:805-388-3595
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice