Healthcare Provider Details

I. General information

NPI: 1659238616
Provider Name (Legal Business Name): DALSIA FARROW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18627 JACKSON ST
HERMITAGE MO
65668-8204
US

IV. Provider business mailing address

PO BOX 125
HERMITAGE MO
65668-0125
US

V. Phone/Fax

Practice location:
  • Phone: 417-745-2134
  • Fax:
Mailing address:
  • Phone: 417-745-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2001017129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: