Provider Demographics
NPI:1770179426
Name:JOANNE NGO & TINA NGO, DDS, INC.
Entity Type:Organization
Organization Name:JOANNE NGO & TINA NGO, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:THU
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-694-3575
Mailing Address - Street 1:2319 OGDEN SANNAZOR DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-8902
Mailing Address - Country:US
Mailing Address - Phone:415-694-3575
Mailing Address - Fax:
Practice Address - Street 1:1100 SONOMA AVE STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8901
Practice Address - Country:US
Practice Address - Phone:415-694-3575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty