NPI | 1649625518 |
---|---|
Former Name | LISA MARIE ATLAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 10913) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OH 30.024996) |
Enumeration Date | 2016-04-28 |
Last Update Date | 2023-10-10 |