NPI | 1861525818 |
---|---|
Former Name | GINA CUC PHAM |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411775) |
Additional Taxonomies | 122300000X Dentist (Licence: MD 13454) |
1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1001433) | |
Enumeration Date | 2007-03-13 |
Last Update Date | 2021-03-17 |