Basic Information
| Provider Information | |||||||||
| NPI: | 1588198535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AIKEN | ||||||||
| FirstName: | TAMMIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 702 N BYERS AVE | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173961881 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4016 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CASSVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 656259753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178470057 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2017 | ||||||||
| LastUpdateDate: | 04/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 003301 | MO | Y | Dental Providers | Dental Hygienist |
No ID Information.