Provider Demographics
NPI:1740679521
Name:DAHL, DOROTHEA (RDLD)
Entity type:Individual
Prefix:
First Name:DOROTHEA
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1581 DODD DR
Mailing Address - Street 2:487C MCCAMPBELL HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1257
Mailing Address - Country:US
Mailing Address - Phone:614-293-5469
Mailing Address - Fax:
Practice Address - Street 1:1581 DODD DR
Practice Address - Street 2:487C MCCAMPBELL HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1257
Practice Address - Country:US
Practice Address - Phone:614-293-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD710133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered