| NPI | 1467893198 |
|---|---|
| Former Name | EMILEE JEAN WENTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 60559041) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC DGD.8259) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2015-07-15 |