Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30.026627 | OH |
N | 1223P0106X | Oral and Maxillofacial Pathology | RES.004421 | OH |
NPI | 1700551835 |
---|---|
Provider Name | Dr. Gabrielle Rochelle Dennis |
First Address | Columbus, OH 43220-3368 |
Second Address | Columbus, OH 43210-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2021 |
Last Update Date | 17/08/2021 |