| NPI | 1255821443 |
|---|---|
| Former Name | MICHELLE CAROLYN WIECZYNSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401416151) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401416151) |
| Enumeration Date | 2018-05-14 |
| Last Update Date | 2024-02-24 |