Provider Demographics
NPI:1043603848
Name:PUFNOCK, JOANNA M (DDS)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:PUFNOCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 WHITE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3037
Mailing Address - Country:US
Mailing Address - Phone:315-521-8003
Mailing Address - Fax:
Practice Address - Street 1:148 WHITE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3037
Practice Address - Country:US
Practice Address - Phone:315-521-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059109122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist