| NPI | 1124366794 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN015291) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 28408) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 9909) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 28408) | |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2017-05-31 |