=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700639390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DSOFC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2024
-----------------------------------------------------
Last Update Date | 04/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3780 W JONATHAN MOORE PIKE STE 180
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47201-9430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-342-9666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3180 MIDDLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47203-2298
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-447-9935
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. KATHERINE E FERRY
-----------------------------------------------------
Credential | DDS, MSD
-----------------------------------------------------
Telephone | 812-350-4465
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------