Provider Demographics
NPI:1801615109
Name:JOHLL, JACQUELIN JOANN (RDH)
Entity type:Individual
Prefix:
First Name:JACQUELIN
Middle Name:JOANN
Last Name:JOHLL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JACQUELIN
Other - Middle Name:
Other - Last Name:SCHNEIDER, TRENARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:865 N ARIZOLA RD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6011
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:
Practice Address - Street 1:865 N ARIZOLA RD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6011
Practice Address - Country:US
Practice Address - Phone:520-836-3446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH009562124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist