NPI | 1700498631 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: MA DN10000024) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 13103) |
122300000X Dentist (Licence: FL DN25132) | |
Enumeration Date | 2020-08-21 |
Last Update Date | 2024-08-29 |