| NPI | 1770315202 |
|---|---|
| Former Name | MARIA JESUS LOPEZ MELENDEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MN FL70) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: MN H11793) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2024-08-14 |