| NPI | 1558786301 |
|---|---|
| Former Name | ELIZABETH MARIE MATTESON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OH RES.3250) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413253) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2014-03-03 |