Provider Demographics
NPI:1235337692
Name:SOOHO JOE,DDS,INC
Entity Type:Organization
Organization Name:SOOHO JOE,DDS,INC
Other - Org Name:SOOHO JOE DDS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SOOHO
Authorized Official - Middle Name:
Authorized Official - Last Name:JOE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-398-9288
Mailing Address - Street 1:51807 HARRISON ST STE 102-103
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-1524
Mailing Address - Country:US
Mailing Address - Phone:760-398-9288
Mailing Address - Fax:760-398-9215
Practice Address - Street 1:51807 HARRISON ST STE 102-103
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1524
Practice Address - Country:US
Practice Address - Phone:760-398-9288
Practice Address - Fax:760-398-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty