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General NPI Number Information
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NPI Number | 1164318531
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Entity Type | Individual
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Provider Name | JANNELLE MORAD DMD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 4929 S BALDWIN RD STE 104
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City | LAKE ORION
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State | MI
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Zip | 48359-2118
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Country | US
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Telephone | 248-221-1743
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Fax |
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Provider Business Mailing Address
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Address Line | 44611 MERRILL RD
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City | STERLING HEIGHTS
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State | MI
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Zip | 48314-1452
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Country | US
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Telephone | 248-918-8753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901602557
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License Number State | MI
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