NPI | 1184852188 |
---|---|
Former Name | DEBRA A MATTHEWS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: GA 9700) |
Additional Taxonomies | 122300000X Dentist (Licence: PA DS021298L) |
Enumeration Date | 2009-06-29 |
Last Update Date | 2009-06-29 |