| NPI | 1376619452 |
|---|---|
| Former Name | COLLEEN GILLILAND RAFFERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019500) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 7292) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2009-04-01 |