Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | RES.2972 | OH |
NPI | 1912200239 |
---|---|
Provider Name | Dr. Gisele Mainville |
First Address | Columbus, OH 43215-2274 |
Second Address | Columbus, OH 43210-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2010 |
Last Update Date | 08/12/2010 |