NPI | 1609302207 |
---|---|
Former Name | ALYSSA GAIL FLASHBURG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL 161479) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041375) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-05-03 |
Last Update Date | 2023-07-13 |