Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 15250 | OH |
NPI | 1093050684 |
---|---|
Provider Name | David J Messick |
First Address | Columbus, OH 43210-1267 |
Second Address | Columbus, OH 43210-1267 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2012 |
Last Update Date | 07/12/2012 |