NPI | 1912125899 |
---|---|
Former Name | COURTNEY ANN ZADELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30.023557) |
Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023557) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH Limited Teaching) | |
Enumeration Date | 2007-04-23 |
Last Update Date | 2019-12-18 |