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General NPI Number Information
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NPI Number | 1366504656
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND COSMETIC SURGERY OF DUBLIN, INC
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 6905 HOSPITAL DRIVE ROAD SUITE 230
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City | DUBLIN
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State | OH
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Zip | 43016
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Country | US
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Telephone | 614-761-7705
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Fax | 614-734-9570
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Provider Business Mailing Address
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Address Line | 6905 HOSPITAL DRIVE ROAD SUITE 230
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City | DUBLIN
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State | OH
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Zip | 43016
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Country | US
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Telephone | 614-761-7705
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Fax | 614-734-9570
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY BETH LUCA
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Credential | D.O.
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Telephone | 614-761-7705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 34005944
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License Number State | OH
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