Healthcare Provider Details

I. General information

NPI: 1700587482
Provider Name (Legal Business Name): TORI ALAYNE DAVIS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHCARE PL
BOWLING GREEN MO
63334-3602
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 573-603-1460
  • Fax:
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-246-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2019019748
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: