Provider Demographics
NPI:1124102892
Name:TESONIERO, JOHANNA J (DDS)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:J
Last Name:TESONIERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:J
Other - Last Name:CAMILO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7425 E SHEA BLVD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6411
Mailing Address - Country:US
Mailing Address - Phone:602-616-5175
Mailing Address - Fax:
Practice Address - Street 1:7425 E SHEA BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6411
Practice Address - Country:US
Practice Address - Phone:480-443-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ65461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice