| NPI | 1679149512 |
|---|---|
| Former Name | SAMANTHA BORNAMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2021019500) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2021019500) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN.00205698) | |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2024-10-21 |