Individual
KITRINA ROXANNE MALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTAL HYGIENIST
Contact information
Practice address
2415 MASSACHUSETTS ST, LAWRENCE, KS 66046-4827
(785) 832-4803
Mailing address
414 2ND ST, BALDWIN CITY, KS 66006-5074
(785) 594-2488
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2588
KS
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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