Provider Demographics
NPI:1992035786
Name:DR. JO'S FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DR. JO'S FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-927-1112
Mailing Address - Street 1:8209 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201-6110
Mailing Address - Country:US
Mailing Address - Phone:562-927-1112
Mailing Address - Fax:562-927-7366
Practice Address - Street 1:8209 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-6110
Practice Address - Country:US
Practice Address - Phone:562-927-1112
Practice Address - Fax:562-927-7366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB28668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28668Medicaid
CA1013088723OtherNPI (INDIVIDUAL)