| NPI | 1588875934 |
|---|---|
| Former Name | CAMILLE JACKSON WORTHINGTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN17873) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4211) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 4211) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2011-10-19 |