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NPI 1083341507

NPI 1083341507 : CHARLA J MCGUIRE RDH; PHDH : PARIS, IL

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General NPI Number Information
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    NPI Number           |    1083341507
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    Entity Type          |    Individual 
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    Provider Name        |    CHARLA J MCGUIRE RDH; PHDH
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    08/04/2022
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    Last Update Date     |    08/04/2022
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Provider Practice Location Address
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    Address Line         |    502 SHAW AVE 
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    City                 |    PARIS
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    State                |    IL
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    Zip                  |    61944-2352
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    Country              |    US
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    Telephone            |    217-465-2212
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    712 VANCE ST 
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    City                 |    PARIS
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    State                |    IL
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    Zip                  |    61944-1158
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    Country              |    US
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    Telephone            |    217-663-7787
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    Fax                  |    
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    124Q00000X
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    Taxonomy Name        |    Dental Hygienist
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    License Number       |    
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    License Number State |    
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