Healthcare Provider Details

I. General information

NPI: 1689059073
Provider Name (Legal Business Name): ALYSSA WILLIAMS DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA PHILLIPS

II. Dates (important events)

Enumeration Date: 07/27/2015
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 COMMUNICATION DR
HANNIBAL MO
63401-3670
US

IV. Provider business mailing address

900 E LAHARPE ST
KIRKSVILLE MO
63501-4520
US

V. Phone/Fax

Practice location:
  • Phone: 573-603-1460
  • Fax: 573-603-1462
Mailing address:
  • Phone: 660-665-1962
  • Fax: 660-665-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2015011459
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: