| NPI | 1285085274 |
|---|---|
| Former Name | MEGAN ELYSE PENTICOFF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-10171) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D13717) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2024-08-14 |