Amber Graham

Individual provider Active NPI Dental Hygienist · Sikeston, MO

NPI 1386058352 · NPPES record last updated Jun 17, 2014

Key facts

NPI
1386058352
Entity type
Individual (NPI type 1)
Primary specialty
Dental Hygienist 124Q00000X
License
2011017337 (MO)
Practice address
220 Southland Dr
Sikeston, MO 63801-4403
Phone
(573) 471-4167
Fax
(573) 471-4212
NPI assigned
Jun 17, 2014
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

LicenseStateTypeSpecialty
2011017337MOMDDental Hygienist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 2011017337 MO Yes

Addresses

Primary practice location

220 Southland Dr
Sikeston, MO 63801-4403

Mailing address

420 Semo Dr
PO Box 400
New Madrid, MO 63869-1734
Phone (573) 748-2404

Other providers in Sikeston, MO

All providers in Sikeston, MO · Dental Hygienist in Missouri

Sources for this page

Verify at the official NPI Registry.