| NPI | 1306413364 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS044506) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH -) |
| 1223G0001X Dentist General Practice (Licence: OH 30.026562) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: NJ 22DI03020200) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2024-06-26 |