Healthcare Provider Details

I. General information

NPI: 1548237761
Provider Name (Legal Business Name): DELBERTA M CRONBAUGH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301A E PRICE AVE
SAVANNAH MO
64485-1739
US

IV. Provider business mailing address

301A E PRICE AVE
SAVANNAH MO
64485-1739
US

V. Phone/Fax

Practice location:
  • Phone: 816-324-5644
  • Fax: 816-324-6307
Mailing address:
  • Phone: 816-324-5644
  • Fax: 816-324-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number002607
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: