NPI | 1417488651 |
---|---|
Former Name | KAITLIN ELIZABETH MARTIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1858482) |
Additional Taxonomies | 122300000X Dentist (Licence: MA s42646050) |
Enumeration Date | 2017-03-21 |
Last Update Date | 2019-09-18 |