Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 13496 | OH |
NPI | 1033273230 |
---|---|
Provider Name | Dr. Alven Lee Herstig |
First Address | Columbus, OH 43213-2436 |
Second Address | Columbus, OH 43213-2436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |