Provider Demographics
NPI:1285069609
Name:NGO, JOANNE THU (DDS)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:THU
Last Name:NGO
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 1:1100 SONOMA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-8901
Mailing Address - Country:US
Mailing Address - Phone:707-525-1600
Mailing Address - Fax:
Practice Address - Street 1:1100 SONOMA AVE STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-8901
Practice Address - Country:US
Practice Address - Phone:075-251-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60899060122300000X
CA62607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist