| NPI | 1407019425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELODY R THOMAS Business Adminstrator 614-885-2022 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: OH 14424) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 17188) |
| 1223G0001X Dentist, General Practice (Licence: OH 13652) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2012-10-29 |