Provider Demographics
NPI:1952556789
Name:WELLINGS, JOANNE M (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:M
Last Name:WELLINGS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STATE HIIGHWAY 310
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-386-2325
Mailing Address - Fax:315-386-2203
Practice Address - Street 1:80 STATE HIIGHWAY 310
Practice Address - Street 2:SUITE #2
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-2325
Practice Address - Fax:315-386-2203
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019839-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019839-1OtherNYS RDH LICENSE #