Provider Demographics
NPI:1649388190
Name:SERDINOW, JOANN MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:MARIE
Last Name:SERDINOW
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:JOANN
Other - Middle Name:MARIE
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14902-1554
Mailing Address - Country:US
Mailing Address - Phone:607-734-7107
Mailing Address - Fax:607-734-7334
Practice Address - Street 1:1118 CHARLES STREET
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14902-1554
Practice Address - Country:US
Practice Address - Phone:607-734-7107
Practice Address - Fax:607-734-7334
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021501DUP124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist