Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 22DI02656600 | NJ |
N | 122300000X | Dentist | DDS100902 | CA |
Y | 1223P0221X | Pediatric Dentist | DDS100902 | CA |
NPI | 1033522578 |
---|---|
Provider Name | Dr. Joanna Cory Aceto |
First Address | Los Angeles, CA 90010-2814 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 21/06/2018 |