Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 3728 | OH |
NPI | 1295185494 |
---|---|
Provider Name | Shelby Dib |
First Address | Columbus, OH 43210-1240 |
Second Address | Columbus, OH 43210-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 22/05/2019 |