| NPI | 1780059915 |
|---|---|
| Former Name | JONNA MARIE VANDAVEER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT DEN-DEN-LIC-9718) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2016-09-20 |