Healthcare Provider Details

I. General information

NPI: 1073299780
Provider Name (Legal Business Name): DENTAL HYGIENE PRACTICE OF JOYCE PANOPIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20950 DELORAINE DR
WALNUT CA
91789-2522
US

IV. Provider business mailing address

20950 DELORAINE DR
WALNUT CA
91789-2522
US

V. Phone/Fax

Practice location:
  • Phone: 626-488-6503
  • Fax:
Mailing address:
  • Phone: 626-488-6503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name: JOYCE PANOPIO
Title or Position: PRESIDENT
Credential: RDH,RDHAP
Phone: 626-488-6503