| NPI | 1285895359 |
|---|---|
| Former Name | ANNA SHIBANOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS037358) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 50053964) |
| Enumeration Date | 2008-06-21 |
| Last Update Date | 2016-04-12 |