Provider Demographics
NPI:1538638226
Name:IANNUCCI, JOEN M (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOEN
Middle Name:M
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:JOEN
Other - Middle Name:IANNUCCI
Other - Last Name:HARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:305 W 12TH AVE RM 4171
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-292-1249
Mailing Address - Fax:
Practice Address - Street 1:305 W 12TH AVE RM 4171
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-292-1249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.018027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist