MEDICARE: DSOFC LLC

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
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)
2	122300000X	Dentist

General Provider Information

NPI Number	:	1700639390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DSOFC LLC

Provider Business Mailing Address
First Line	:	3180 MIDDLE RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-2298
Country	:	US
Telephone Number	:	812-447-9935
Fax Number	:

Provider Business Practice Location Address
First Line	:	3780 W JONATHAN MOORE PIKE STE 180
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-9430
Country	:	US
Telephone Number	:	812-342-9666
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KATHERINE E FERRY
Credential	:	DDS, MSD
Telephone Number	:	812-350-4465

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/11/2024

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Directions to “DSOFC LLC ” Practice Location

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