| NPI | 1831884436 |
|---|---|
| Former Name | MIRANDA LYNN ANDERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5521) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61604888) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2026-07-17 |