| NPI | 1104024264 |
|---|---|
| Former Name | AMY JEAN HAWORTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D12729) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 6709) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2009-07-08 |