Healthcare Provider Details

I. General information

NPI: 1538851597
Provider Name (Legal Business Name): MINDY ANN PARKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 MARSHALL DR
SAINT ROBERT MO
65584-5603
US

IV. Provider business mailing address

441 MARSHALL DR
SAINT ROBERT MO
65584-5603
US

V. Phone/Fax

Practice location:
  • Phone: 573-336-5599
  • Fax:
Mailing address:
  • Phone: 573-336-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2009022320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: