| NPI | 1164989349 |
|---|---|
| Former Name | AMANDA JEANETTE MITCHELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 34250) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 34250) |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NM DD5581) | |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-09-07 |