Individual
MRS. SHANNON KELLY MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1204 HWY 164 E, OQUAWKA, IL 61469
(309) 867-2770
(309) 867-3205
Mailing address
PO BOX 129 OQUAWKA IL 61469, 111 S. 10TH ST. OQUAWKA IL 61469, OQUAWKA, IL 61469
(319) 759-6644
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020.011534
IL
Other
Enumeration date
08/12/2020
Last updated
08/12/2020
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