| NPI | 1639482474 |
|---|---|
| Former Name | JAIME BETH WIEBUSCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D12840) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D12840) |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2019-04-19 |