NPI | 1396427795 |
---|---|
Former Name | LESIA LOUISE JUSTICE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: NC 6857) |
Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: SD 3364) |
Enumeration Date | 2023-08-04 |
Last Update Date | 2023-08-04 |