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General NPI Number Information
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NPI Number | 1770179426
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Entity Type | Organization
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Legal Business Name | JOANNE NGO & TINA NGO, DDS, INC.
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 1100 SONOMA AVE STE D
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City | SANTA ROSA
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State | CA
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Zip | 95405-8901
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Country | US
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Telephone | 415-694-3575
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Fax |
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Provider Business Mailing Address
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Address Line | 2319 OGDEN SANNAZOR DR
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City | TRACY
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State | CA
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Zip | 95377-8902
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Country | US
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Telephone | 415-694-3575
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOANNE THU NGO
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Credential | DDS
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Telephone | 415-694-3575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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