| NPI | 1952593360 |
|---|---|
| Former Name | JENNIFER LEAH HENDRICKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SD D0964) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019656) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2020-08-25 |