| NPI | 1881094068 |
|---|---|
| Former Name | TESSIE BURACZEWSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: ME DEN4593) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039922) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2018-10-13 |