Cassie Jo Boultinghouse, RDH
Individual provider Active NPI Dental Hygienist · Nevada, MO
NPI 1962211482 · NPPES record last updated Dec 31, 2024
Key facts
- NPI
- 1962211482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 2006018226 (MO)
- Practice address
- 301 W Austin Blvd
Nevada, MO 64772-3124 - Phone
- (844) 853-8937
- NPI assigned
- Dec 31, 2024
- 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 |
|---|---|---|---|
| 2006018226 | MO | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2006018226 | MO | Yes |
Addresses
Primary practice location
301 W Austin Blvd
Nevada, MO 64772-3124
Mailing address
1800 Community
Clinton, MO 64735-8804
Phone (660) 885-8131
Other names
- Cassie Jo Crews
Other providers in Nevada, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2024. 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.