Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 71-000222 | OH |
NPI | 1225306301 |
---|---|
Provider Name | Dr. Elisandra Reyes-Perez |
First Address | Columbus, OH 43210-1267 |
Second Address | Columbus, OH 43210-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2011 |
Last Update Date | 05/12/2011 |