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General NPI Number Information
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NPI Number | 1184019218
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Entity Type | Individual
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Provider Name | SARAH M CONLEY-DE JESUS RDH
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Gender | Female
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Dates
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Enumeration Date | 04/06/2015
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 6010 W MAPLE RD SUITE 210
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4406
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Country | US
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Telephone | 248-214-9594
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Fax | 248-419-6124
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Provider Business Mailing Address
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Address Line | 6010 W MAPLE RD SUITE 210
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4406
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Country | US
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Telephone | 248-214-9594
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Fax | 248-419-6124
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902016989
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License Number State | MI
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