Provider Demographics
NPI:1407811441
Name:MOILANEN, ELLEN M (RDH)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:MOILANEN
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:W4974 NUMBER 40 RD
Mailing Address - Street 2:
Mailing Address - City:HERMANSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49847-9593
Mailing Address - Country:US
Mailing Address - Phone:906-498-2152
Mailing Address - Fax:
Practice Address - Street 1:N 16088 BALSAM LN
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:MI
Practice Address - Zip Code:49886
Practice Address - Country:US
Practice Address - Phone:906-497-5263
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2092006449124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist