Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 29594 | MO |
NPI | 1447384417 |
---|---|
Provider Name | Dr. Chyrelle Louann Blount |
First Address | Forsyth, MO 65653-1357 |
Second Address | Forsyth, MO 65653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |