Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 18543 | OH |
NPI | 1700865201 |
---|---|
Provider Name | Dr. Mark D Raisch |
First Address | Columbus, OH 43214-2637 |
Second Address | Columbus, OH 43214-2637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 06/01/2017 |