Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 12475 | OH |
NPI | 1003038175 |
---|---|
Provider Name | Timothy C Hall |
First Address | Columbus, OH 43214-3437 |
Second Address | Columbus, OH 43214-3437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |