Healthcare Provider Details

I. General information

NPI: 1700017910
Provider Name (Legal Business Name): JOSEPHINE DIGIACINTO DOVIDIO DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 ROYAL AVE SUITE 230
SIMI VALLEY CA
93065-4665
US

IV. Provider business mailing address

2045 ROYAL AVE SUITE 230
SIMI VALLEY CA
93065-4665
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-9242
  • Fax: 805-529-5030
Mailing address:
  • Phone: 805-522-9242
  • Fax: 805-529-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number45244
License Number StateCA

VIII. Authorized Official

Name: JOSEPHINE DIGIACINTO DOVIDIO
Title or Position: OWNER / DENTIST
Credential: DDS
Phone: 805-522-9242