NPI | 1396301578 |
---|---|
Former Name | JENNA ELISE SWOTINSKY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1858623) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858623) |
Enumeration Date | 2019-05-14 |
Last Update Date | 2021-12-14 |