| NPI | 1881264786 |
|---|---|
| Former Name | HEATHER NICHOLAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11530) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2026-08-19 |