Provider Demographics
NPI:1285036764
Name:LAMARCHE, JOLEEN (RDH)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:
Last Name:LAMARCHE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35717 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-6161
Mailing Address - Country:US
Mailing Address - Phone:715-644-0674
Mailing Address - Fax:
Practice Address - Street 1:35717 50TH AVE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:WI
Practice Address - Zip Code:54768-6161
Practice Address - Country:US
Practice Address - Phone:715-644-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6846-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIJOLEEN LAMARCHEMedicaid