| NPI | 1972656338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist Periodontics (Licence: CO DEN00201944) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 8277) |
| 122300000X Dentist (Licence: MI 2901020133) | |
| 1223P0300X Dentist Periodontics (Licence: MA DN1855725) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2015-03-04 |