NPI | 1124423959 |
---|---|
Former Name | KAYLA BATEMAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NV s3-309) |
Additional Taxonomies | 122300000X Dentist (Licence: NV 6550) |
Enumeration Date | 2014-10-22 |
Last Update Date | 2018-08-23 |