| NPI | 1871701854 |
|---|---|
| Former Name | STACEY LAURA SIMMONS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT 2141) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MT 2141) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2019-05-13 |