Individual
ROSALYN SULYANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 355-0777
Mailing address
100 E GAY ST UNIT 203, COLUMBUS, OH 43215-3169
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN1855702
MA
122300000X
Dentist
RES.3114
OH
1223P0221X
Pediatric Dentistry
Primary
DN1855702
MA
Other
Enumeration date
06/20/2011
Last updated
06/24/2013
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