Healthcare Provider Details

I. General information

NPI: 1225082134
Provider Name (Legal Business Name): HEALTH SPECIALISTS OF DAYTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1126 S MAIN ST
DAYTON OH
45409-2687
US

IV. Provider business mailing address

1126 S MAIN ST
DAYTON OH
45409-2687
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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 937-208-8213