| NPI | 1891812194 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NY 045913) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 045913) |
| 1223G0001X Dentist, General Practice (Licence: NY 045913) | |
| 1223P0700X Dentist, Prosthodontics (Licence: NY 045913) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: NY 045913) | |
| 124Q00000X Dental Hygienist (Licence: NY 045913) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2007-11-23 |