Individual
MRS. BRENDA MICHELE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
4260 FORT HENRY DR STE 13, KINGSPORT, TN 37663-2248
(423) 239-6594
Mailing address
421 HILL PARK DR, BRISTOL, VA 24201-2626
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
0402208559
VA
124Q00000X
Dental Hygienist
Primary
10293
TN
Other
Enumeration date
05/22/2023
Last updated
05/22/2023
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