| NPI | 1467199083 |
|---|---|
| Former Name | TERAH LEIGH WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN26857) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2024-05-30 |