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General NPI Number Information
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NPI Number | 1770729048
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Entity Type | Organization
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Legal Business Name | FINGLETON FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 600 36TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-4005
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Country | US
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Telephone | 616-532-9600
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Fax | 616-532-9602
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Provider Business Mailing Address
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Address Line | 600 36TH ST SW
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City | WYOMING
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State | MI
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Zip | 49509-4005
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Country | US
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Telephone | 616-532-9600
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Fax | 616-532-9602
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Authorized Official
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Title or Position | OWNER
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Name | DR. ILIANA MIREYE FINGLETON
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Credential | DDS
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Telephone | 616-532-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901019111
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License Number State | MI
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