NPI | 1851685697 |
---|---|
Former Name | TARA NICOLE GAINEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 28536) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2011-06-08 |
Last Update Date | 2021-11-30 |