| NPI | 1245383793 | 
|---|---|
| Former Name | GEORGETTE BRAGAN | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DE G1-0001094)  | 
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DE 1094)  | 
| Enumeration Date | 2007-01-19 | 
| Last Update Date | 2019-08-26 |