NPI | 1538139076 |
---|---|
Former Name | DEBORAH MARIE MICKELSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN17382) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17382) |
Enumeration Date | 2006-01-26 |
Last Update Date | 2024-07-10 |