Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30022294 | OH |
NPI | 1003901968 |
---|---|
Provider Name | Jennifer E Rekos |
First Address | Worthington, OH 43085-3962 |
Second Address | Worthington, OH 43085-3962 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |