Provider Demographics
NPI:1205028859
Name:TAVITIAN, JOELLE A (DDS)
Entity Type:Individual
Prefix:MS
First Name:JOELLE
Middle Name:A
Last Name:TAVITIAN
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 1:165 LOCKFORD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-0952
Mailing Address - Country:US
Mailing Address - Phone:949-285-4749
Mailing Address - Fax:714-389-4647
Practice Address - Street 1:165 LOCKFORD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-0952
Practice Address - Country:US
Practice Address - Phone:949-285-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463351223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics