| NPI | 1285204925 |
|---|---|
| Former Name | SAMANTHA ELISE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NE 7953) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2023-08-31 |