Healthcare Provider Details

I. General information

NPI: 1407345416
Provider Name (Legal Business Name): DANA S ADKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2018
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 POE AVE STE 100
DAYTON OH
45414-2678
US

IV. Provider business mailing address

6640 POE AVE STE 100
DAYTON OH
45414-2678
US

V. Phone/Fax

Practice location:
  • Phone: 937-617-2273
  • Fax: 937-387-9987
Mailing address:
  • Phone: 937-617-2273
  • Fax: 937-387-9987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1610097-TRNE
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: