| NPI | 1659832475 |
|---|---|
| Former Name | GRACE M BERNHARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: FL 24212) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6991) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2019-07-01 |