Healthcare Provider Details

I. General information

NPI: 1700639390
Provider Name (Legal Business Name): DSOFC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 W JONATHAN MOORE PIKE STE 180
COLUMBUS IN
47201-9430
US

IV. Provider business mailing address

3180 MIDDLE RD
COLUMBUS IN
47203-2298
US

V. Phone/Fax

Practice location:
  • Phone: 812-342-9666
  • Fax:
Mailing address:
  • Phone: 812-447-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE E FERRY
Title or Position: OWNER
Credential: DDS, MSD
Phone: 812-350-4465