MEDICARE: DR. JOSEPH JONARIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	47893	CA

General Provider Information

NPI Number	:	1336294156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH JONARIS D.D.S.

Provider Business Mailing Address
First Line	:	3516 JASMINE AVE
Second Line	:	109
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-4960
Country	:	US
Telephone Number	:	310-838-4653
Fax Number	:

Provider Business Practice Location Address
First Line	:	5828 SANTA MONICA BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-2002
Country	:	US
Telephone Number	:	323-871-9191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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