Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 14314 | OH |
NPI | 1063662195 |
---|---|
Provider Name | Greg L Offenburger |
First Address | Columbus, OH 43229-6478 |
Second Address | Columbus, OH 43229-6478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2008 |
Last Update Date | 25/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T48192 | (02) | OH |