Individual
AILENE INVENCION KANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1081 E 18TH ST, ROLLA, MO 65401-2448
(573) 426-2407
Mailing address
1081 E 18TH ST, ROLLA, MO 65401-2448
(573) 426-2407
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2019023445
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400071481
—
MO
Enumeration date
06/26/2019
Last updated
06/24/2021
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