| 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 |