Provider Demographics
NPI:1487658860
Name:MIHAILA-MOTIU, JOANA CODRUTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANA
Middle Name:CODRUTA
Last Name:MIHAILA-MOTIU
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:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249
Mailing Address - Country:US
Mailing Address - Phone:809-754-9565
Mailing Address - Fax:209-754-9922
Practice Address - Street 1:40 E SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:209-754-9565
Practice Address - Fax:209-754-9922
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist