| NPI | 1619359247 |
|---|---|
| Former Name | STEPHANIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11166) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021566) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2023-06-13 |