Provider Demographics
NPI:1760455885
Name:TOOTLE, JOAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:TOOTLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOANN
Other - Middle Name:M
Other - Last Name:TOOTLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D D S
Mailing Address - Street 1:1321 S M 33
Mailing Address - Street 2:
Mailing Address - City:MIO
Mailing Address - State:MI
Mailing Address - Zip Code:48647-9518
Mailing Address - Country:US
Mailing Address - Phone:989-826-5444
Mailing Address - Fax:989-826-6067
Practice Address - Street 1:1321 S M 33
Practice Address - Street 2:
Practice Address - City:MIO
Practice Address - State:MI
Practice Address - Zip Code:48647-9518
Practice Address - Country:US
Practice Address - Phone:989-826-5444
Practice Address - Fax:989-826-6067
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI138381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice