NPI | 1407438856 |
---|---|
Former Name | SYDNEY NICOLE CULLOP |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: KY 10588) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 4532) |
Enumeration Date | 2021-04-26 |
Last Update Date | 2021-06-28 |