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General NPI Number Information
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NPI Number | 1366466716
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Entity Type | Individual
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Provider Name | JO-ANN CAROL DE JESUS AFRICA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 15165 SEVENTH ST STE I
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City | VICTORVILLE
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State | CA
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Zip | 92395-3816
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Country | US
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Telephone | 760-245-7704
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Fax | 760-245-0115
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Provider Business Mailing Address
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Address Line | 15691 MONTGOMERY DR
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City | FONTANA
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State | CA
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Zip | 92336-1770
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Country | US
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Telephone | 626-377-0668
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54133
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License Number State | CA
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