| NPI | 1962491639 |
|---|---|
| Former Name | SHEVA TERESA NICKRAVESH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 51629) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 51629) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2024-02-29 |