Kloanna Fetolli, DDS
Individual provider Active NPI Dentist · Wixom, MI
NPI 1558055400 · NPPES record last updated Jun 5, 2023
Key facts
- NPI
- 1558055400
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901601753 (MI)
- Practice address
- 3255 W Maple Rd Ste a
Wixom, MI 48393-4585 - Phone
- (734) 837-4462
- NPI assigned
- Jun 5, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| 2901601753 | MI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901601753 | MI | Yes |
Addresses
Primary practice location
3255 W Maple Rd Ste a
Wixom, MI 48393-4585
Mailing address
7298 Willow Creek Dr
Canton, MI 48187-2422
Phone (734) 837-4462
Other providers in Wixom, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2023. 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.