| NPI | 1376029397 |
|---|---|
| Former Name | CARISSA LEE SMARDO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AR 4510) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2018017944) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2021-08-30 |