| NPI | 1801923123 |
|---|---|
| Former Name | STEPHANIE LEE COSBY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MO 2007027546) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: KY 7967) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-12-18 |