| NPI | 1366060386 |
|---|---|
| Former Name | MAKAYLA BROOKE GRESHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WV 4521) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 11861) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2022-08-26 |