Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2010018781 | MO |
NPI | 1033420039 |
---|---|
Provider Name | Meagan Whitley Berry |
First Address | Ellington, MO 63638-0157 |
Second Address | Ellington, MO 63638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2010 |
Last Update Date | 04/08/2011 |