Provider Demographics
NPI:1003278409
Name:JOAN THANH TO DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOAN THANH TO DENTAL CORPORATION
Other - Org Name:DENTISTS OF SOUTH BAY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-752-4998
Mailing Address - Street 1:17000 RED HILL AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5626
Mailing Address - Country:US
Mailing Address - Phone:714-845-8870
Mailing Address - Fax:949-474-1495
Practice Address - Street 1:5023 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5441
Practice Address - Country:US
Practice Address - Phone:310-752-4998
Practice Address - Fax:310-526-3486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty