NPI | 1639669815 |
---|---|
Former Name | KATHRYN JEAN SHERIDAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416478) |
Additional Taxonomies | 122300000X Dentist (Licence: VA 1639669815) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-05-14 |
Last Update Date | 2022-03-01 |