Provider Demographics
NPI:1033120860
Name:JOE, JEFFREY WING (W) (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WING (W)
Last Name:JOE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W. MONTEBELLO BL.
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4603
Mailing Address - Country:US
Mailing Address - Phone:323-721-0799
Mailing Address - Fax:323-721-5513
Practice Address - Street 1:604 W. MONTEBELLO BL.
Practice Address - Street 2:SUITE B
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4603
Practice Address - Country:US
Practice Address - Phone:323-721-0799
Practice Address - Fax:323-721-5513
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist