| NPI | 1588007306 |
|---|---|
| Former Name | MARY DISA MALLARD RAULFS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401414341) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN R544) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2014-05-14 |