NPI | 1679923080 |
---|---|
Former Name | CHARITY VANDER WALL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: NC 10800) |
Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001627) |
Enumeration Date | 2016-06-16 |
Last Update Date | 2022-07-21 |