Healthcare Provider Details

I. General information

NPI: 1255301560
Provider Name (Legal Business Name): SOUTHWEST OHIO ENT SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S PATTERSON BLVD SUITE 400
DAYTON OH
45402-2684
US

IV. Provider business mailing address

1222 S PATTERSON BLVD SUITE 400
DAYTON OH
45402-2684
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL E YOUNG
Title or Position: BUSINESS MANAGER
Credential:
Phone: 937-496-2620