Provider Demographics
NPI:1861124919
Name:POWERS, DALEY M (DENTAL HYGENTIST)
Entity type:Individual
Prefix:
First Name:DALEY
Middle Name:M
Last Name:POWERS
Suffix:
Gender:F
Credentials:DENTAL HYGENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SEMO DR
Mailing Address - Street 2:
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-1734
Mailing Address - Country:US
Mailing Address - Phone:573-748-2440
Mailing Address - Fax:573-748-5443
Practice Address - Street 1:741 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BERNIE
Practice Address - State:MO
Practice Address - Zip Code:63822-8900
Practice Address - Country:US
Practice Address - Phone:573-293-6930
Practice Address - Fax:573-293-6841
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022022937124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist