MEDICARE: DR. JOANA CODRUTA MIHAILA-MOTIU DDS

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	47641	CA

General Provider Information

NPI Number	:	1487658860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANA CODRUTA MIHAILA-MOTIU DDS

Provider Business Mailing Address
First Line	:	PO BOX 369
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249
Country	:	US
Telephone Number	:	809-754-9565
Fax Number	:	209-754-9922

Provider Business Practice Location Address
First Line	:	40 E SAINT CHARLES ST
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249
Country	:	US
Telephone Number	:	209-754-9565
Fax Number	:	209-754-9922

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	12/29/2016

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