Healthcare Provider Details

I. General information

NPI: 1477594000
Provider Name (Legal Business Name): DAYTON EAR NOSE & THROAT SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7076 CORPORATE WAY
CENTERVILLE OH
45459-4281
US

IV. Provider business mailing address

7076 CORPORATE WAY
CENTERVILLE OH
45459-4281
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-0555
  • Fax: 937-434-7413
Mailing address:
  • Phone: 937-434-0555
  • Fax: 937-434-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0016AS
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN HAYES BOYLES JR.
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 937-434-0555