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 |