NPI | 1326301144 |
---|---|
Former Name | JESSICA A DOMBROSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: VA 0401414614) |
Additional Taxonomies | 122300000X Dentist (Licence: FL DN19726) |
Enumeration Date | 2012-06-18 |
Last Update Date | 2021-01-07 |