Healthcare Provider Details

I. General information

NPI: 1568943488
Provider Name (Legal Business Name): CHELSEA L ISGRIG RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W MULBERRY SUITE B
PILOT KNOB MO
63663-0327
US

IV. Provider business mailing address

PO BOX 19214
BELFAST ME
04915-4087
US

V. Phone/Fax

Practice location:
  • Phone: 573-546-1001
  • Fax: 573-546-1002
Mailing address:
  • Phone: 573-663-2313
  • Fax: 573-663-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2014015952
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: