| NPI | 1508187626 |
|---|---|
| Former Name | KELLI ELLEN VANHOUTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AR 3773) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 11199) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2021-02-11 |