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Individual
SION NA
Active
Individual
SION NA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
062439
NY
1223G0001X
General Practice Dentistry
0401417914
VA
1223G0001X
General Practice Dentistry
DEN2000281
DC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/18/2021
Last updated
05/04/2025
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