Jurrica Justyne Stanley, RDH
Individual provider Active NPI Dental Hygienist · Baldwin, MI
NPI 1114563145 · NPPES record last updated Nov 25, 2019
Key facts
- NPI
- 1114563145
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 2902019171 (MI)
- Practice address
- 1615 Michigan Ave
Baldwin, MI 49304-7984 - Phone
- (231) 745-5051
- Fax
- (231) 745-0412
- NPI assigned
- Nov 25, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2902019171 | MI | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2902019171 | MI | Yes |
Addresses
Primary practice location
1615 Michigan Ave
Baldwin, MI 49304-7984
Mailing address
1615 Michigan Ave
Baldwin, MI 49304-7984
Phone (231) 745-5051
Other providers in Baldwin, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 25, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.