NPI | 1770922940 |
---|---|
Former Name | JENNA LAUREN BEHRENTS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: KS 61944) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D008754) |
122300000X Dentist (Licence: KS 61944) | |
1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MO 2017004356) | |
Enumeration Date | 2013-06-20 |
Last Update Date | 2025-07-03 |