| NPI | 1114249091 |
|---|---|
| Former Name | MICHELLE KELLY PHILLIPS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA 05039987) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 59136) |
| 122300000X Dentist (Licence: PA DS039987) | |
| Enumeration Date | 2010-02-19 |
| Last Update Date | 2022-01-28 |