Provider Demographics
NPI:1104017359
Name:KANNELL, JOANNE (DMD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:KANNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-325-0964
Mailing Address - Fax:973-325-6202
Practice Address - Street 1:81 NORTHFIELD AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-0964
Practice Address - Fax:973-325-6202
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ14310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist