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General NPI Number Information
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NPI Number | 1154614675
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Entity Type | Organization
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Legal Business Name | DISCOVER DENTAL LLC
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Dates
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Enumeration Date | 05/17/2011
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 2872 STELZER RD
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City | COLUMBUS
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State | OH
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Zip | 43219-3133
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Country | US
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Telephone | 614-476-3368
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Fax |
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Provider Business Mailing Address
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Address Line | 2872 STELZER ROAD
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City | COLUMBUS
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State | OH
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Zip | 43219
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Country | US
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Telephone | 614-476-3368
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | MOHAMED WARSAME
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Credential | DMD
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Telephone | 614-476-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30023314
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License Number State | OH
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