=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568192334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNA FINN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2022
-----------------------------------------------------
Last Update Date | 06/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 E CEDAR AVE
-----------------------------------------------------
City | GLADWIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48624-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-426-4597
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4620 TROTTERS POINTE CIR
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48642-6859
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-773-9419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 2901601254
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------