| NPI | 1750470951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANJA SUZANNE WODA Ins Coord 614-263-4040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OH 21749) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 22026) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-08-22 |