| NPI | 1447596655 |
|---|---|
| Former Name | KALLIE LYNN LAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8162) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN014538) |
| Enumeration Date | 2012-12-14 |
| Last Update Date | 2015-02-15 |