Provider Demographics
NPI:1699905562
Name:FAHR, JOSEPH P (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:FAHR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PEYMAN
Other - Middle Name:
Other - Last Name:POURFAKHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1431WEST 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:310-866-7162
Mailing Address - Fax:
Practice Address - Street 1:1431 W KNOX ST STE 800
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1358
Practice Address - Country:US
Practice Address - Phone:310-320-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice