NPI | 1770906992 |
---|---|
Former Name | JESSICA FRANCES KRAVIT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 64173) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 00000000000000000000) |
Enumeration Date | 2014-01-23 |
Last Update Date | 2015-09-03 |