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General NPI Number Information
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NPI Number | 1750927232
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Entity Type | Individual
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Provider Name | TIMBERLY SUE DAOUST RDH
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 302 S FRONT ST STE A
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City | DOWAGIAC
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State | MI
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Zip | 49047-1750
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Country | US
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Telephone | 269-782-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 4774 BAHAMA LN
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City | PORTAGE
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State | MI
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Zip | 49002-9045
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Country | US
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Telephone | 269-271-2291
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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 | 2902013577
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License Number State |
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