| NPI | 1538474986 |
|---|---|
| Former Name | IRENE SEA HADDOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020004) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN-10206) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2012-07-10 |