Provider Demographics
NPI:1558055400
Name:FETOLLI, KLOANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KLOANNA
Middle Name:
Last Name:FETOLLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7298 WILLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2422
Mailing Address - Country:US
Mailing Address - Phone:734-837-4462
Mailing Address - Fax:
Practice Address - Street 1:3255 W MAPLE RD STE A
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-4585
Practice Address - Country:US
Practice Address - Phone:734-837-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601753122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist