| NPI | 1417059478 |
|---|---|
| Former Name | JAN RAY SHIRLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058246) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 60345) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2016-07-28 |