Individual
AUDRA DEE BERGQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
850 FAIRWAY DR, CHILLICOTHE, MO 64601-3673
(660) 646-3802
Mailing address
413 N 9TH ST, WAKEENEY, KS 67672-1911
(785) 259-0678
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2024020430
MO
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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