| NPI | 1689950420 |
|---|---|
| Former Name | INGRID CELESTE DE JESUS PENA GUZMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1855829) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |