NPI | 1083926174 |
---|---|
Former Name | DANA MARIE KOSSICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 11655) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 26045) |
1223P0221X Dentist, Pediatric Dentistry (Licence: CA 59164) | |
Enumeration Date | 2010-07-06 |
Last Update Date | 2025-01-16 |