Provider Demographics
NPI:1063147437
Name:ALE, JOANNA MOSES (DDS)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MOSES
Last Name:ALE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11867 MASON MONTGOMERY RD STE B
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-4713
Mailing Address - Country:US
Mailing Address - Phone:513-677-0383
Mailing Address - Fax:
Practice Address - Street 1:11867 MASON MONTGOMERY RD STE B
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-4713
Practice Address - Country:US
Practice Address - Phone:513-677-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI600001315122300000X
OH30.026956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist