| NPI | 1649409632 |
|---|---|
| Former Name | LAURA GRACE TUCKER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN18660) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18660) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2013-08-02 |