NPI | 1407890056 |
---|---|
Former Name | TAMMIE LAJUANA ADAMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: MS 3094) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 56262CA) |
Enumeration Date | 2006-06-15 |
Last Update Date | 2008-10-01 |