Individual
MRS. TRACI ANNE SHAMBO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
BLDG. 400 VIRGINIA AVE, FORT LEONARD WOOD, MO 65473
(573) 596-0408
Mailing address
22964 REVELATION RD, WAYNESVILLE, MO 65583-7827
(724) 496-6814
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2012040673
MO
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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