| NPI | 1982907689 |
|---|---|
| Former Name | JAZMIN RIVERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DEN-DEN-LIC-5964) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9545) |
| Enumeration Date | 2010-12-18 |
| Last Update Date | 2014-05-05 |