Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 014389 | OH |
NPI | 1043614944 |
---|---|
Provider Name | Ronald Carmen |
First Address | Columbus, OH 43213-2503 |
Second Address | Columbus, OH 43213-2503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2014 |
Last Update Date | 21/10/2014 |