Healthcare Provider Details

I. General information

NPI: 1063663565
Provider Name (Legal Business Name): KRISTI MARIE DOBBS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N HIGHWAY 71
ANDERSON MO
64831-9753
US

IV. Provider business mailing address

4301 DONIPHAN DR
NEOSHO MO
64850-9120
US

V. Phone/Fax

Practice location:
  • Phone: 417-845-2273
  • Fax:
Mailing address:
  • Phone: 417-451-9450
  • Fax: 417-451-9459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2006021705
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: