Provider Demographics
NPI:1962849257
Name:JOSEPHWAREHAMDMDPA
Entity Type:Organization
Organization Name:JOSEPHWAREHAMDMDPA
Other - Org Name:CHERRY BLOSSOM FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WAREHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:240-682-9166
Mailing Address - Street 1:13431 BOYETTE RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5710
Mailing Address - Country:US
Mailing Address - Phone:813-419-0880
Mailing Address - Fax:
Practice Address - Street 1:13431 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5710
Practice Address - Country:US
Practice Address - Phone:813-419-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18586261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental