Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2014010437 | MO |
NPI | 1093080475 |
---|---|
Provider Name | Dr. Ashley Nicole Popejoy |
First Address | Springfield, MO 65801-5681 |
Second Address | Springfield, MO 65806-1131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2012 |
Last Update Date | 28/01/2016 |