MEDICARE: CAITLIN BILLINGS RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	2015011598	MO

General Provider Information

NPI Number	:	1386191054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN BILLINGS RDH

Provider Business Mailing Address
First Line	:	1003 SW SANDY LN
Second Line	:
City	:	GRAIN VALLEY
State	:	MO
Zip	:	64029-8420
Country	:	US
Telephone Number	:	816-986-9604
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 N BISMARK ST
Second Line	:
City	:	CONCORDIA
State	:	MO
Zip	:	64020-8180
Country	:	US
Telephone Number	:	660-463-0234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	09/09/2016

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