Provider Demographics
NPI:1366714222
Name:JOSEPH P FAHR
Entity type:Organization
Organization Name:JOSEPH P FAHR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:FAHR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-320-1180
Mailing Address - Street 1:1431 W KNOX STREET
Mailing Address - Street 2:SUITE 800
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501
Mailing Address - Country:US
Mailing Address - Phone:310-320-1180
Mailing Address - Fax:310-320-2468
Practice Address - Street 1:1431 W KNOX STREET
Practice Address - Street 2:SUITE 800
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501
Practice Address - Country:US
Practice Address - Phone:310-320-1180
Practice Address - Fax:310-320-2468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN