| NPI | 1356300586 |
|---|---|
| Former Name | KELLY LOUISE BUTTRICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0121080) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021173) |
| 122300000X Dentist (Licence: AK DEND891) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2024-04-25 |