Crystal Jujuan Davis, R.D.H.

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

2902011199 Issued in MI

Practice address

43401 N Jefferson Ave BLDG 825
Selfridge Ang Base
Selfridge Angb, MI 48045-5266

Phone

(586) 239-3005

Fax

(586) 239-5010

NPI assigned

May 8, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Uscg Detroit Pharmacy

  • Military/U.S. Coast Guard Pharmacy
  • Selfridge, MI
  • NPI 1801550843
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336435200000",
    "number": "1982963237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43401 N JEFFERSON AVE BLDG 825",
            "address_2": "SELFRIDGE ANG BASE",
            "city": "SELFRIDGE ANGB",
            "state": "MI",
            "postal_code": "480455266",
            "telephone_number": "586-239-3005",
            "fax_number": "586-239-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43401 N JEFFERSON AVE BLDG 825",
            "address_2": "SELFRIDGE ANG BASE",
            "city": "SELFRIDGE ANGB",
            "state": "MI",
            "postal_code": "480455266",
            "telephone_number": "586-239-3005",
            "fax_number": "586-239-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "CRYSTAL",
        "middle_name": "JUJUAN",
        "name_prefix": "Mrs.",
        "credential": "R.D.H.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-08",
        "last_updated": "2012-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "MI",
            "license": "2902011199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabelle R Doherty
• Andrea Lindsay Hodges, LLMSW
• Brandon Charles Holda
• Diana Lee Kott, RDH
• Dana Marie Kubinski, RDH

• Dental Hygienist in Selfridge Angb, MI
• Providers in Selfridge Angb, MI by specialty
• Dental Hygienist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.