Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 057832 | NY |
N | 1223P0221X | Pediatric Dentist | DS039446 | PA |
Y | 1223P0221X | Pediatric Dentist | G1-0001343 | DE |
NPI | 1063775989 |
---|---|
Provider Name | Dr. Jacqueline Palma Wingate |
First Address | Canandaigua, NY 14424-1787 |
Second Address | Canandaigua, NY 14424-1787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2012 |
Last Update Date | 28/12/2018 |