Traci Anne Shambo, RDH
Dental Hygienist in Fort Leonard Wood, MO. Individual provider (NPI-1).
NPI number1982198453
StatusActive
Last updated in NPPESJun 19, 2018
Details
- NPI
- 1982198453
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Traci Anne Shambo
- Credential
- RDH
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 19, 2018
- Last updated
- Jun 19, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 124Q00000X | Dental Hygienist | 2012040673 | MO | Yes |
Practice location
Bldg. 400 Virginia AveFort Leonard Wood, MO 65473
Phone 573-596-0408
Mailing address
22964 Revelation RdWaynesville, MO 65583-7827
Phone 724-496-6814
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All 13 Dental Hygienist providers in Fort Leonard Wood · All 558 providers in Fort Leonard Wood
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