Healthcare Provider Details

I. General information

NPI: 1255276374
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA ORAL PAIN EXPERTS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12835 POINTE DEL MAR WAY STE 3
DEL MAR CA
92014-3846
US

IV. Provider business mailing address

30435 NORTHGATE DR
SOUTHFIELD MI
48076-1031
US

V. Phone/Fax

Practice location:
  • Phone: 248-633-5965
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA SETH GOLDFADEN
Title or Position: EXECUTIVE DIRECTOR
Credential: DDS
Phone: 248-633-5965