| NPI | 1033937156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE B HICKMAN Contracting & Credentialing Manager 614-844-3800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2024-09-27 |