| NPI | 1306682356 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OK T7947) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OK T7947) |
| 1223P0300X Dentist Periodontics (Licence: OK T7947) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OK T7947) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: OK T7947) | |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2024-07-09 |