| NPI | 1124287123 |
|---|---|
| Former Name | HEATHER CROCKETT-WASHINGTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30.023011) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 010471) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2023-11-01 |