Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 30.022489 | OH |
NPI | 1093889172 |
---|---|
Provider Name | Mark L Oleson |
First Address | Columbus, OH 43214-2300 |
Second Address | Columbus, OH 43214-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 22/07/2010 |