| NPI | 1912980640 |
|---|---|
| Former Name | JENNIFER LEA GRANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AZ 8115) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08118) |
| 122300000X Dentist (Licence: SC 4161) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2011-02-08 |