Healthcare Provider Details

I. General information

NPI: 1518288562
Provider Name (Legal Business Name): DALE W. DROLLINGER, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5676 FAR HILLS AVE
DAYTON OH
45429-2206
US

IV. Provider business mailing address

5676 FAR HILLS AVE
DAYTON OH
45429-2206
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-1854
  • Fax: 937-436-1459
Mailing address:
  • Phone: 937-436-1854
  • Fax: 937-436-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35050973
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11516NP
License Number StateOH

VIII. Authorized Official

Name: DR. DALE WILLIAM DROLLINGER
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 937-436-1854