NPI | 1124142005 |
---|---|
Former Name | CATHY DAWN STEPHENSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 6592) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN 10089) |
1223G0001X Dentist, General Practice (Licence: IA 7232) | |
Enumeration Date | 2007-03-18 |
Last Update Date | 2007-07-08 |