| NPI | 1952553125 |
|---|---|
| Former Name | LISA KLODNITSKAYA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014054) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22DI02376200) |
| 122300000X Dentist (Licence: GA DN014054) | |
| Enumeration Date | 2008-10-19 |
| Last Update Date | 2021-06-28 |