| NPI | 1700940129 |
|---|---|
| Former Name | ERICA NICOLE ELANNAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D05851) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN16541) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2022-10-18 |