Basic Information
| Provider Information | |||||||||
| NPI: | 1124126339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORELLO | ||||||||
| FirstName: | DAHLIA | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1427 VALLEY LAKE DR APT 223 | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601953629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897397927 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2030 PORTAGE ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490013836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163490888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2901019150 | MI | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 4901883 | 05 | MI | MEDICAID |