| NPI | 1356355564 |
|---|---|
| Former Name | JENNIFER LEE GREGORIO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6001141-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21114) |
| 122300000X Dentist (Licence: RI DEN03317) | |
| 1223G0001X Dentist, General Practice (Licence: WI 6001141-15) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2023-06-08 |