NPI | 1205570876 |
---|---|
Former Name | AYANNA BRINEA POWELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: MD 8398) |
Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: LA 5352) |
Enumeration Date | 2022-04-20 |
Last Update Date | 2022-04-20 |