Individual
ZELLISHA ALEXIS QUAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD3884
NM
1223D0001X
Public Health Dentistry
DD3884
NM
Other
Enumeration date
04/03/2012
Last updated
09/19/2013
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