Healthcare Provider Details

I. General information

NPI: 1992487862
Provider Name (Legal Business Name): JOSHUA SETH GOLDFADEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS044329
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number109032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: