| NPI | 1932525136 |
|---|---|
| Former Name | KELSEY DENISE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IN 12013532A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9892) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9892) | |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2021-06-22 |