| NPI | 1316935232 |
|---|---|
| Former Name | NANCY LEE GOODARE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IL 019.030532) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 8414) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2018-10-19 |