Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3664 | OH |
NPI | 1023468790 |
---|---|
Provider Name | Dr. Soorya Srinivasan |
First Address | Dublin, OH 43016-7197 |
Second Address | Columbus, OH 43210-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 16/06/2016 |