NPI | 1861641011 |
---|---|
Former Name | LINDSEY KRECKO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: CO 00202747) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027778) |
122300000X Dentist (Licence: NY 0547631) | |
Enumeration Date | 2008-09-11 |
Last Update Date | 2016-05-10 |