| NPI | 1912394578 |
|---|---|
| Former Name | AUDREY MICHELLE RIESEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10484) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10484) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE61168847) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2023-09-29 |