| NPI | 1578659967 |
|---|---|
| Former Name | LISA G HUDDLESTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN010898) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 046876) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-04-19 |