| NPI | 1619537883 |
|---|---|
| Former Name | JESSICA GRIMMER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901023214) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MI 2901023214) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-06-19 |