| NPI | 1013467588 |
|---|---|
| Former Name | KATHRYN JAN HAVERKOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN1000899) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |