| NPI | 1043530991 |
|---|---|
| Former Name | STACY JACKSON EHLERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO DEN.00202791) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2010016174) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-04-26 |