| NPI | 1184708422 |
|---|---|
| Former Name | TANYA WANDA KORN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 6321) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NE 6321) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2024-06-05 |