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General NPI Number Information
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NPI Number | 1295335891
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Entity Type | Individual
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Provider Name | JANELLE MCQUEEN DDS
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Gender | Female
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Dates
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Enumeration Date | 11/01/2020
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Last Update Date | 11/01/2020
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Provider Practice Location Address
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Address Line | 29702 SOUTHFIELD RD STE H
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2096
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Country | US
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Telephone | 248-559-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 3574 WABEEK LAKE DR W
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-1271
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Country | US
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Telephone |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901022805
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License Number State | MI
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