| NPI | 1740487982 |
|---|---|
| Former Name | ABBY LEE CARLSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901019589) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN013776) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-08-19 |