Healthcare Provider Details

I. General information

NPI: 1477793156
Provider Name (Legal Business Name): DAYTON HEAD AND NECK SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 W 1ST ST SUITE 400
DAYTON OH
45402-3065
US

IV. Provider business mailing address

369 W 1ST ST SUITE 400
DAYTON OH
45402-3065
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2600
  • Fax: 937-496-2610
Mailing address:
  • Phone: 937-496-2620
  • Fax: 937-496-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number212203
License Number StateOH

VIII. Authorized Official

Name: MR. DANIEL YOUNG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 937-496-2600