Renee Blanken

Individual provider Active NPI Dental Hygienist · House Springs, MO

NPI 1740680396 · NPPES record last updated Oct 27, 2014

Key facts

NPI
1740680396
Entity type
Individual (NPI type 1)
Primary specialty
Dental Hygienist 124Q00000X
License
2009020164 (MO)
Practice address
4300 Gravois Rd
House Springs, MO 63051-2304
Phone
(636) 321-0150
NPI assigned
Sep 2, 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
2009020164MOMDDental Hygienist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Hygienist 124Q00000X 2009020164 MO Yes

Addresses

Primary practice location

4300 Gravois Rd
House Springs, MO 63051-2304

Mailing address

227 E Main St
Festus, MO 63028-1952

Other providers in House Springs, MO

All providers in House Springs, MO · Dental Hygienist in Missouri

Sources for this page

Verify at the official NPI Registry.