NPI | 1598019325 |
---|---|
Former Name | STACY LYNN BAKER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901021156) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 319.018288) |
Enumeration Date | 2012-10-31 |
Last Update Date | 2014-10-09 |