Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 17480 | OH |
NPI | 1003973694 |
---|---|
Provider Name | Dwight David Dessart |
First Address | Cincinnati, OH 45202 |
Second Address | Cincinnati, OH 45202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |