| 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 |