MEDICARE: DR. DAWN LOUISE BROYLES 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
1	122300000X	Dentist	30.023231	OH

General Provider Information

NPI Number	:	1306133707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAWN LOUISE BROYLES DDS

Provider Business Mailing Address
First Line	:	1323 MYRTLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1708
Country	:	US
Telephone Number	:	513-541-5599
Fax Number	:	513-541-8956

Provider Business Practice Location Address
First Line	:	1323 MYRTLE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1708
Country	:	US
Telephone Number	:	513-541-5599
Fax Number	:	513-541-8956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	10/27/2022

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