| NPI | 1215466826 |
|---|---|
| Former Name | AMANDA LYNN GLASHEEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MD 16436) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001593) |
| 1223G0001X Dentist General Practice (Licence: MD 16436) | |
| 1223G0001X Dentist General Practice (Licence: WI 1001593) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2021-03-12 |