| NPI | 1689130858 |
|---|---|
| Former Name | KRYSTLE CLARKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: DC DEN1001931) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1001931) |
| 122300000X Dentist (Licence: MD 17193) | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2026-03-03 |