| NPI | 1558786889 |
|---|---|
| Former Name | KRISTEN MARIE BONKOWSKI |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VT 016.0134062) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856545) |
| 122300000X Dentist (Licence: GA DN014807) | |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2022-03-22 |