NPI | 1841789468 |
---|---|
Former Name | TIFFANY JULIANA LEWIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA DN1858594) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-05-09 |
Last Update Date | 2024-07-08 |