NPI | 1316469653 |
---|---|
Former Name | KATELYN MICHELLE KENNEDY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 37083) |
Enumeration Date | 2017-07-07 |
Last Update Date | 2023-09-29 |