| NPI | 1104442722 |
|---|---|
| Former Name | KELLEY FISCHER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN24881) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24881) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2023-01-07 |