| NPI | 1235417858 |
|---|---|
| Former Name | LAURIE KATHARINE MCCULLOUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: CA DDS62336) |
| Enumeration Date | 2011-07-31 |
| Last Update Date | 2022-07-21 |