| NPI | 1629649009 |
|---|---|
| Former Name | GRACEN MARIE MCGUCKIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 38839) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-07-07 |
| Last Update Date | 2023-06-02 |