| NPI | 1255527016 |
|---|---|
| Former Name | KELLY JONES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00010940) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401412425) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2022-08-09 |