| NPI | 1982218673 |
|---|---|
| Former Name | MARISSA FERNANDEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 36598) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36598) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2022-08-18 |