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Individual
ULISES ERNESTO CARBALLOSA FERNANDEZ
Active
Individual
ULISES ERNESTO CARBALLOSA FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30.028142
OH
390200000X
Student in an Organized Health Care Education/Training Program
RES.004578
OH
Other
Enumeration date
05/15/2023
Last updated
07/17/2025
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