| NPI | 1508028820 |
|---|---|
| Former Name | CAROLYN CASSIDY DICUS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 1001168) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 150661) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WI 64325) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-07-21 |