Provider Demographics
NPI:1164318531
Name:MORAD, JANNELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JANNELLE
Middle Name:
Last Name:MORAD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44611 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1452
Mailing Address - Country:US
Mailing Address - Phone:248-918-8753
Mailing Address - Fax:
Practice Address - Street 1:4929 S BALDWIN RD STE 104
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2118
Practice Address - Country:US
Practice Address - Phone:248-221-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901602557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist