| NPI | 1205967155 |
|---|---|
| Former Name | MARTHA ELLEN GERDSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 30-022401) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 2501) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2009-12-31 |