| NPI | 1609846930 |
|---|---|
| Former Name | MAURA SLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: FL DN19715) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2018-12-03 |