Provider Demographics
NPI:1447384417
Name:BLOUNT, CHYRELLE LOUANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHYRELLE
Middle Name:LOUANN
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MO
Mailing Address - Zip Code:65653-1357
Mailing Address - Country:US
Mailing Address - Phone:479-283-3470
Mailing Address - Fax:
Practice Address - Street 1:15479 US HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MO
Practice Address - Zip Code:65653
Practice Address - Country:US
Practice Address - Phone:417-546-4725
Practice Address - Fax:417-546-4727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO295941223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health