Individual
MRS. IRENE BROYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
209 S WASHINGTON ST, RAYMORE, MO 64083-9729
(816) 331-3456
(816) 331-0035
Mailing address
209 S WASHINGTON ST, RAYMORE, MO 64083-9729
(816) 331-3456
(816) 331-0035
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
015460
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
421427364
TAX ID
MO
Enumeration date
05/07/2007
Last updated
07/08/2007
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