Provider Demographics
NPI:1770729048
Name:FINGLETON FAMILY DENTISTRY
Entity type:Organization
Organization Name:FINGLETON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILIANA
Authorized Official - Middle Name:MIREYE
Authorized Official - Last Name:FINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-532-9600
Mailing Address - Street 1:600 36TH ST SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4005
Mailing Address - Country:US
Mailing Address - Phone:616-532-9600
Mailing Address - Fax:616-532-9602
Practice Address - Street 1:600 36TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4005
Practice Address - Country:US
Practice Address - Phone:616-532-9600
Practice Address - Fax:616-532-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019111261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental