| NPI | 1285781005 |
|---|---|
| Former Name | TRACIE PREVATTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901019493) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-08-05 |