| NPI | 1124412945 |
|---|---|
| Former Name | JENNIFER LYNN MITCHELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 30709) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-03-19 |