| NPI | 1922535657 |
|---|---|
| Former Name | JESSICA ALLISON GOODMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16378) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415578) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2023-11-01 |