| NPI | 1164719290 |
|---|---|
| Former Name | JESSICA SHRECK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CO 00203431) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WY 1690) |
| Enumeration Date | 2011-07-10 |
| Last Update Date | 2025-12-04 |