Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30.024171 | OH |
NPI | 1003159385 |
---|---|
Provider Name | Scott Jerome Hudepohl |
First Address | Cincinnati, OH 45247-6245 |
Second Address | Cincinnati, OH 45247-6245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2013 |
Last Update Date | 15/02/2017 |