| NPI | 1427365444 |
|---|---|
| Former Name | BERNADETE THERRIAULT CAMPOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MA DN1857008) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL10842) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2019-12-02 |