NPI | 1770613754 |
---|---|
Former Name | CLEOKA ALESHA THOMPSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8916) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 3593) |
1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013295) | |
Enumeration Date | 2007-03-07 |
Last Update Date | 2023-12-13 |