Healthcare Provider Details

I. General information

NPI: 1952556789
Provider Name (Legal Business Name): JOANNE M WELLINGS R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 STATE HIIGHWAY 310 SUITE #2
CANTON NY
13617
US

IV. Provider business mailing address

80 STATE HIIGHWAY 310 SUITE #2
CANTON NY
13617
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-2325
  • Fax: 315-386-2203
Mailing address:
  • Phone: 315-386-2325
  • Fax: 315-386-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number019839-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: