| NPI | 1922771161 |
|---|---|
| Former Name | CHASE KOETTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12014027A) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17501) |
| Enumeration Date | 2021-07-25 |
| Last Update Date | 2023-08-06 |