Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 21918 | OH |
NPI | 1386706703 |
---|---|
Provider Name | Dr. Jacob Karl Mohr |
First Address | Lima, OH 45804-2482 |
Second Address | Lima, OH 45804-2482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 10/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2795695 | (05) | OH |