| NPI | 1205095932 |
|---|---|
| Former Name | JENNIFER BERTHIAUME |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 2699) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019775) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2022-09-22 |