Provider Demographics
NPI:1407509482
Name:QUEEN, BRITTANY (RDH)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:QUEEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-9400
Mailing Address - Country:US
Mailing Address - Phone:573-663-2313
Mailing Address - Fax:
Practice Address - Street 1:315 W MULBERRY STE B
Practice Address - Street 2:
Practice Address - City:PILOT KNOB
Practice Address - State:MO
Practice Address - Zip Code:63663-7860
Practice Address - Country:US
Practice Address - Phone:573-546-1001
Practice Address - Fax:573-546-1002
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016015092124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist