Beverly Jaye Dillow, RDH
Individual provider Active NPI Dental Hygienist · Advance, MO
NPI 1265734941 · NPPES record last updated Dec 1, 2010
Key facts
- NPI
- 1265734941
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 2001005622 (MO)
- Practice address
- 307 Gabriel St
Advance, MO 63730-0039 - Phone
- (573) 722-3034
- Fax
- (573) 722-3244
- NPI assigned
- Dec 1, 2010
- 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 |
|---|---|---|---|
| 2001005622 | MO | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2001005622 | MO | Yes |
Addresses
Primary practice location
307 Gabriel St
Advance, MO 63730-0039
Mailing address
307 Gabriel St
Advance, MO 63730-0039
Phone (573) 722-3034
Other providers in Advance, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2010. 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.