Healthcare Provider Details

I. General information

NPI: 1184119091
Provider Name (Legal Business Name): DOMINIC COMBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S PATTERSON BLVD
DAYTON OH
45402-2649
US

IV. Provider business mailing address

8560 TWIN CREEK DR
WAYNESVILLE OH
45068-7006
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: