Healthcare Provider Details

I. General information

NPI: 1619809308
Provider Name (Legal Business Name): EVGENYIA ALWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4353 CHATEAU DE VILLE DR APT H
SAINT LOUIS MO
63129-1827
US

IV. Provider business mailing address

4353 CHATEAU DE VILLE DR APT H
SAINT LOUIS MO
63129-1827
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1800
  • Fax: 513-984-4909
Mailing address:
  • Phone: 513-984-1800
  • Fax: 513-984-4909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2013036795
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: