Basic Information
Provider Information
NPI: 1033557467
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FINNERTY
FirstName: GILLIAN
MiddleName: HODGKIN
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 331 W PARRISH LN STE 101
Address2:  
City: CENTERVILLE
State: UT
PostalCode: 840141853
CountryCode: US
TelephoneNumber: 8013763183
FaxNumber:  
Practice Location
Address1: 331 W PARRISH LN
Address2: STE 101
City: CENTERVILLE
State: UT
PostalCode: 840141852
CountryCode: US
TelephoneNumber: 8012983230
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/07/2013
LastUpdateDate: 06/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X9787091-9922UTY Dental ProvidersDentist 
122300000X30.023995OHN Dental ProvidersDentist 

No ID Information.


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