| NPI | 1063645745 |
|---|---|
| Former Name | KNIEEKA SHANELL JAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 29374) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62350) |
| 122300000X Dentist (Licence: MO 200916780) | |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2018-08-28 |