Healthcare Provider Details

I. General information

NPI: 1104065275
Provider Name (Legal Business Name): DAYTON CARDIOLOGY AND VASC CONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 1ST ST STE 100
DAYTON OH
45402-3046
US

IV. Provider business mailing address

1126 S MAIN ST
DAYTON OH
45409-2616
US

V. Phone/Fax

Practice location:
  • Phone: 937-223-3053
  • Fax: 937-853-0166
Mailing address:
  • Phone: 937-223-3053
  • Fax: 937-853-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L TURNER
Title or Position: SCHEDULING/CREDENTIALING
Credential:
Phone: 937-223-3053