| NPI | 1750768263 |
|---|---|
| Former Name | JESSICA LYNN SULLIVAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60791472) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13801) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MN D13801) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RR60541536) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2018-06-25 |