Healthcare Provider Details

I. General information

NPI: 1245347285
Provider Name (Legal Business Name): DALTON & VAN FOSSEN SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ARCH ST SUITE 280
AKRON OH
44304-1437
US

IV. Provider business mailing address

95 ARCH ST SUITE 280
AKRON OH
44304-1437
US

V. Phone/Fax

Practice location:
  • Phone: 330-564-2438
  • Fax: 330-564-2443
Mailing address:
  • Phone: 330-564-2438
  • Fax: 330-564-2443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35064327
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35062167D
License Number StateOH

VIII. Authorized Official

Name: MRS. DEBBIE SUE CRAIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 330-564-2438