| NPI | 1184958225 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SERRA Member 614-451-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OH 023093) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 014666) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2009-09-22 |