Provider Demographics
NPI:1104855584
Name:DI GIACINTO-DOVIDIO, JOSEPHINE V (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:V
Last Name:DI GIACINTO-DOVIDIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 ROYAL AVE
Mailing Address - Street 2:#230
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4665
Mailing Address - Country:US
Mailing Address - Phone:805-522-9242
Mailing Address - Fax:805-529-5030
Practice Address - Street 1:2045 ROYAL AVE
Practice Address - Street 2:#230
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4665
Practice Address - Country:US
Practice Address - Phone:805-522-9242
Practice Address - Fax:805-529-5030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA452441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice