| NPI | 1174962955 |
|---|---|
| Former Name | JACLYN R THOMURE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61004) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013042705) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2023-11-26 |