NPI | 1962506659 |
---|---|
Former Name | LAQUANIS SHENA COLLINS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014862) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 4240) |
Enumeration Date | 2006-09-12 |
Last Update Date | 2016-03-14 |