NPI | 1124330592 |
---|---|
Former Name | JULIE JO POWELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: OK 6242) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D8013) |
Enumeration Date | 2010-07-13 |
Last Update Date | 2011-09-26 |