Provider Demographics
NPI:1366466716
Name:AFRICA, JO-ANN CAROL DE JESUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JO-ANN CAROL
Middle Name:DE JESUS
Last Name:AFRICA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JO-ANN CAROL
Other - Middle Name:ELIGAN
Other - Last Name:DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:15691 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1770
Mailing Address - Country:US
Mailing Address - Phone:626-377-0668
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice