Healthcare Provider Details

I. General information

NPI: 1710477187
Provider Name (Legal Business Name): ASHLYN ELIZABETH SAPPINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 MAIN ST
BOONVILLE MO
65233
US

IV. Provider business mailing address

1601 SPIROS DR APT A
COLUMBIA MO
65202-5520
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-6095
  • Fax:
Mailing address:
  • Phone: 636-395-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2015015545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: