Healthcare Provider Details

I. General information

NPI: 1386191054
Provider Name (Legal Business Name): CAITLIN BILLINGS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N BISMARK ST
CONCORDIA MO
64020-8180
US

IV. Provider business mailing address

1003 SW SANDY LN
GRAIN VALLEY MO
64029-8420
US

V. Phone/Fax

Practice location:
  • Phone: 660-463-0234
  • Fax:
Mailing address:
  • Phone: 816-986-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2015011598
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: