Individual
SUMMER LANE
Active
Individual
SUMMER LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DS-041228
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
S2-180
NV
Other
Enumeration date
08/27/2014
Last updated
06/10/2022
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