Provider Demographics
NPI:1891874897
Name:MARATHE, KAUSTUBH K (DDS)
Entity Type:Individual
Prefix:
First Name:KAUSTUBH
Middle Name:K
Last Name:MARATHE
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 1:28410 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-1818
Mailing Address - Country:US
Mailing Address - Phone:951-506-6555
Mailing Address - Fax:951-694-6550
Practice Address - Street 1:28410 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 110
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-1818
Practice Address - Country:US
Practice Address - Phone:951-506-6555
Practice Address - Fax:951-694-6550
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice