Provider Demographics
NPI:1841435666
Name:FINGLETON, ILIANA MIREYE (DDS)
Entity type:Individual
Prefix:DR
First Name:ILIANA
Middle Name:MIREYE
Last Name:FINGLETON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019111122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist