| NPI | 1871581074 |
|---|---|
| Former Name | JENNIFER MAE FEDERLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 8093) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8093) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2022-07-21 |