| NPI | 1386831550 |
|---|---|
| Former Name | JUSTINA MELISSA SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 48855) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 48855) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2013-07-31 |