| NPI | 1518273200 |
|---|---|
| Former Name | JACQUELYN RAE KOLBECK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MN D13177) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: SD Temp287) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2014-05-12 |