| NPI | 1609269174 |
|---|---|
| Former Name | JUSTENE DOAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 49874) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 49874) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2024-10-31 |