Provider Demographics
NPI:1215009642
Name:CHOUINARD, JOANNE D (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:D
Last Name:CHOUINARD
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6384 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2541
Mailing Address - Country:US
Mailing Address - Phone:773-767-4200
Mailing Address - Fax:773-767-4340
Practice Address - Street 1:6384 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2541
Practice Address - Country:US
Practice Address - Phone:773-767-4200
Practice Address - Fax:773-767-4340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190187751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice