NPI | 1083878896 |
---|---|
Former Name | JOLENE MARIE HERMES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-08542) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08542) |
Enumeration Date | 2008-07-11 |
Last Update Date | 2015-01-12 |