Provider Demographics
NPI:1326269846
Name:JOYNER, NICOLE TUCKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:TUCKER
Last Name:JOYNER
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 1:3971 HUBERT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2619
Mailing Address - Country:US
Mailing Address - Phone:310-594-9509
Mailing Address - Fax:
Practice Address - Street 1:2711 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-5527
Practice Address - Country:US
Practice Address - Phone:323-231-2108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD49553Medicaid