| NPI | 1336505635 |
|---|---|
| Former Name | SPENCER MCKENZIE MACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 30007) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2022-10-24 |