| NPI | 1841648466 |
|---|---|
| Former Name | ANDRINA MICHELLE SHANNON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: GA 011980) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: FL 19428) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2016-05-25 |