Provider Demographics
NPI:1609959626
Name:PACO, JOHANNA CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:CAROL
Last Name:PACO
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 1:2440 W VIA ACOSTA
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2344
Mailing Address - Country:US
Mailing Address - Phone:714-335-4997
Mailing Address - Fax:
Practice Address - Street 1:2440 W VIA ACOSTA
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2344
Practice Address - Country:US
Practice Address - Phone:714-335-4997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice