Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 30-023082 | OH |
NPI | 1689806549 |
---|---|
Provider Name | Kelsey Esber |
First Address | Mansfield, OH 44906-2633 |
Second Address | Mansfield, OH 44906-2633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2009 |
Last Update Date | 29/07/2010 |