Healthcare Provider Details

I. General information

NPI: 1790272748
Provider Name (Legal Business Name): ORAL PATHOLOGY CONSULTANTS LABORATORY, LLC - JOHN R KALMAR, DMD PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-1472
  • Fax: 614-688-3553
Mailing address:
  • Phone: 614-292-1472
  • Fax: 614-688-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. LINDA MYERS
Title or Position: DIRECTOR
Credential: MHHA
Phone: 614-292-1472