| NPI | 1497964381 |
|---|---|
| Former Name | HEATHER TIFFANY MOMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: TX 21206) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |