| NPI | 1659630663 |
|---|---|
| Former Name | MARITA IZMAILOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 056224) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02486600) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2015-05-12 |