NPI | 1174963904 |
---|---|
Former Name | ERICA ANN STUTIUS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401415316) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 10132) |
1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1856846) | |
Enumeration Date | 2013-06-25 |
Last Update Date | 2016-09-30 |