| NPI | 1508165168 |
|---|---|
| Former Name | ALYSSA LYN VANGILDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 7186) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2011014462) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2014-07-31 |