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General NPI Number Information
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NPI Number | 1811462369
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Entity Type | Organization
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Legal Business Name | JO-ANN DE JESUS AFRICA DDS INC
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Dates
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Enumeration Date | 10/11/2018
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Last Update Date | 10/11/2018
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Provider Practice Location Address
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Address Line | 15375 BASELINE AVE STE 5
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City | FONTANA
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State | CA
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Zip | 92336-5774
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Country | US
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Telephone | 909-904-7778
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Fax | 877-983-7726
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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 | 626-377-8909
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Fax | 877-983-7726
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JO-ANN DE JESUS AFRICA
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Credential | DDS
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Telephone | 909-904-7778
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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 |
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License Number State |
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