Provider Demographics
NPI:1033768635
Name:JO-ANN AFRICA DDS INC
Entity Type:Organization
Organization Name:JO-ANN AFRICA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:AFRICA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-245-7704
Mailing Address - Street 1:15165 SEVENTH ST STE I
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3816
Mailing Address - Country:US
Mailing Address - Phone:760-245-7704
Mailing Address - Fax:760-245-0115
Practice Address - Street 1:15165 SEVENTH ST STE I
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3816
Practice Address - Country:US
Practice Address - Phone:760-245-7704
Practice Address - Fax:760-245-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty