Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 30.026546 | OH |
NPI | 1013584689 |
---|---|
Provider Name | Galina Valentinovna Bulatova |
First Address | Wooster, OH 44691-5541 |
Second Address | Wooster, OH 44691-5541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2021 |
Last Update Date | 10/06/2021 |