| NPI | 1992044119 |
|---|---|
| Former Name | BRENNA MICHELLE GOODWIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00203696) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00103693) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2021-12-31 |