Healthcare Provider Details

I. General information

NPI: 1467447623
Provider Name (Legal Business Name): OTTO R. DUENO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/06/2022
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL SUITE G-3
DAYTON OH
45417-3445
US

IV. Provider business mailing address

1748 CEDAR RIDGE DR
SPRING VALLEY OH
45370-9783
US

V. Phone/Fax

Practice location:
  • Phone: 937-281-0900
  • Fax: 937-281-0930
Mailing address:
  • Phone: 937-848-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35066509
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: