Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | RES.003810 | OH |
NPI | 1063933794 |
---|---|
Provider Name | Dr. Caroline Bissonnette |
First Address | Columbus, OH 43212-1209 |
Second Address | Columbus, OH 43210-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 27/03/2020 |