Provider Demographics
NPI:1972755965
Name:PASSAMANO, JOSEPH PETER (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:PASSAMANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14982 SAND CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92650-9000
Mailing Address - Country:US
Mailing Address - Phone:949-572-7708
Mailing Address - Fax:
Practice Address - Street 1:14982 SAND CANYON AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92650-9000
Practice Address - Country:US
Practice Address - Phone:949-572-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice