| NPI | 1194003624 |
|---|---|
| Former Name | CALLISTA MARIE OWEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WY 1285) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 95) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2012-08-03 |