| NPI | 1790040616 |
|---|---|
| Former Name | KATIE ELIZABETH WOLZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0004X Dentist Dentist Anesthesiologist (Licence: TN 10221) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 10221) |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2016-07-11 |