Individual
DR. CAMILLE RENEE TAGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2305 S BLACKMAN RD STE 100, SPRINGFIELD, MO 65809-2845
(417) 887-3860
Mailing address
3411 S OAK AVE, SPRINGFIELD, MO 65804-4831
(913) 709-6764
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2018018453
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
MO
Enumeration date
06/09/2018
Last updated
06/09/2018
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