| NPI | 1053381681 |
|---|---|
| Former Name | MARY ANGELA DIETRICH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: VA 0401411871) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: IL 019-025050) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2010-06-01 |