Healthcare Provider Details

I. General information

NPI: 1891217626
Provider Name (Legal Business Name): JEMMA JOY NOLAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEMMA JOY ALLOR

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 MACK AVE
DETROIT MI
48207-2302
US

IV. Provider business mailing address

105 CHURCH ST
MOUNT CLEMENS MI
48043-2216
US

V. Phone/Fax

Practice location:
  • Phone: 313-331-3435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902012531
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: