Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 71.000216 | OH |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 71000216 | OH |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 30-024214 | OH |
NPI | 1093974867 |
---|---|
Provider Name | Dr. Deepak Gopala Krishnan |
First Address | Cincinnati, OH 45263-0579 |
Second Address | Cincinnati, OH 45219-4231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 26/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2900874 | (05) | OH |