| NPI | 1326578865 |
|---|---|
| Former Name | SHADAE ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401415686) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415686) |
| 122300000X Dentist (Licence: FL DN24803) | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2021-09-30 |