Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | RES 3411 | OH |
Y | 1223P0221X | Pediatric Dentist | 30-024676 | OH |
NPI | 1093120529 |
---|---|
Provider Name | Laura Marie Doss |
First Address | Cincinnati, OH 45227-3002 |
Second Address | Crestview Hills, KY 41017-3424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 13/05/2016 |