| NPI | 1225774300 |
|---|---|
| Former Name | MARY ANNA ARLENE ELLIOTT ONTIVEROS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 38501) |
| Enumeration Date | 2022-05-11 |
| Last Update Date | 2024-03-06 |