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NPI Code Detail

MEDICARE: LEAH ROSALYN TATE DDS

MEDICARE: LEAH ROSALYN TATE DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist30022450OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12682039OTHEROHMOLINA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124180039
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH ROSALYN TATE DDS
Provider Business Mailing Address
First Line : 5770 KARL RD
Second Line : SUITE 100
City : COLUMBUS
State : OH
Zip : 43229-3604
Country : US
Telephone Number : 614-846-8340
Fax Number : 614-846-8345
Provider Business Practice Location Address
First Line : 5770 KARL RD
Second Line : SUITE 100
City : COLUMBUS
State : OH
Zip : 43229-3604
Country : US
Telephone Number : 614-846-8340
Fax Number : 614-846-8345
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2006
Last Update Date : 06/11/2012

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Directions to “ LEAH ROSALYN TATE DDS” Practice Location

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