Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | RES.3447 | OH |
NPI | 1023409349 |
---|---|
Provider Name | Jennifer Burzynski |
First Address | Columbus, OH 43210-1267 |
Second Address | Columbus, OH 43210-1267 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2015 |
Last Update Date | 09/02/2015 |