Provider Demographics
NPI:1063775989
Name:WINGATE, JACQUELINE PALMA (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:PALMA
Last Name:WINGATE
Suffix:
Gender:F
Credentials:DMD, MPH
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Mailing Address - Street 1:325 WEST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1787
Mailing Address - Country:US
Mailing Address - Phone:585-394-4058
Mailing Address - Fax:585-394-6108
Practice Address - Street 1:325 WEST ST STE 101
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1787
Practice Address - Country:US
Practice Address - Phone:585-394-4058
Practice Address - Fax:585-394-6108
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS0394461223P0221X
NY0578321223P0221X
DEG1-00013431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry