| NPI | 1366877250 |
|---|---|
| Former Name | KOURTNEY ADELE SIMPSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 17840) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9756) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9756) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2024-03-06 |