Provider Demographics
NPI:1811462369
Name:JO-ANN DE JESUS AFRICA DDS INC
Entity type:Organization
Organization Name:JO-ANN DE JESUS AFRICA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JO-ANN
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:AFRICA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-904-7778
Mailing Address - Street 1:15691 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-1770
Mailing Address - Country:US
Mailing Address - Phone:626-377-8909
Mailing Address - Fax:877-983-7726
Practice Address - Street 1:15375 BASELINE AVE STE 5
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5774
Practice Address - Country:US
Practice Address - Phone:909-904-7778
Practice Address - Fax:877-983-7726
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JO-ANN DE JESUS AFRICA DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty