Individual
AUTUMN ROSE VANGENNIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 332-0808
(573) 339-7945
Mailing address
408 S BROADVIEW ST, CAPE GIRARDEAU, MO 63703-5725
(573) 382-2127
(573) 339-7945
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2011017963
MO
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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