| NPI | 1992194195 |
|---|---|
| Former Name | MARISSA LUDLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10377) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021436) |
| Enumeration Date | 2015-01-12 |
| Last Update Date | 2019-01-01 |