NPI | 1669669719 |
---|---|
Former Name | STACY ALBINDER BOETTCHER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: AZ 5159) |
Additional Taxonomies | 122300000X Dentist (Licence: CA 59249) |
Enumeration Date | 2007-10-02 |
Last Update Date | 2012-01-27 |