| NPI | 1689931891 |
|---|---|
| Former Name | EMILIE MCCLELLAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: KS 60912) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2014043200) |
| 1223G0001X Dentist, General Practice (Licence: KS 60912) | |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2021-06-02 |