| NPI | 1124142773 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 910) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023178) |
| 122300000X Dentist (Licence: AK 1010) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9425) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 9156) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-07-09 |