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NPI Code Detail

MEDICARE: PEGGY SUE KENYON RDH

MEDICARE: PEGGY SUE KENYON RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist633WY

General Provider Information

NPI Number : 1316084239
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY SUE KENYON RDH
Provider Business Mailing Address
First Line : 6900 ALDEN DR
Second Line :
City : FT WARREN AFB
State : WY
Zip : 82005-3906
Country : US
Telephone Number : 307-773-1846
Fax Number : 307-773-3550
Provider Business Practice Location Address
First Line : 6900 ALDEN DR
Second Line :
City : FT WARREN AFB
State : WY
Zip : 82005-3906
Country : US
Telephone Number : 307-773-1846
Fax Number : 307-773-3550
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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Directions to “ PEGGY SUE KENYON RDH” Practice Location

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