Healthcare Provider Details

I. General information

NPI: 1003363631
Provider Name (Legal Business Name): GIOVANNA DAINTY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 LINCOLN STREET US ARMY DENTAL HEALTH ACTIVITY JBLM
TACOMA WA
98431-0001
US

IV. Provider business mailing address

652 HAMILTON RD. USA DENTAL ACTIVITY
FORT SILL OK
73503
US

V. Phone/Fax

Practice location:
  • Phone: 717-598-3221
  • Fax:
Mailing address:
  • Phone: 580-442-3905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.24788
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: