| NPI | 1568957694 |
|---|---|
| Former Name | SARAH MARIE DETORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MA DN1858076) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-07-01 |
| Last Update Date | 2019-10-20 |