| NPI | 1790795235 |
|---|---|
| Other Name | BREYNNE STACEY FORDAHL RATNAYAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MN D12259) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN 12259) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-11-30 |