Provider Demographics
NPI:1316245244
Name:JO, PHILIP (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:JO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CLOUDBREAK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1153
Mailing Address - Country:US
Mailing Address - Phone:909-435-9471
Mailing Address - Fax:
Practice Address - Street 1:5225 CANYON CREST DR STE 209
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6323
Practice Address - Country:US
Practice Address - Phone:951-686-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484721223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics