| NPI | 1639368145 |
|---|---|
| Former Name | KAILTYN KIEU NGUYEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN23997) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56323) |
| 1223G0001X Dentist, General Practice (Licence: NM DD3790) | |
| Enumeration Date | 2007-10-21 |
| Last Update Date | 2024-12-11 |