Healthcare Provider Details

I. General information

NPI: 1437340825
Provider Name (Legal Business Name): HEALTH SPECIALISTS OF DAYTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL STE 10A
DAYTON OH
45408-1445
US

IV. Provider business mailing address

1 ELIZABETH PL STE 10A
DAYTON OH
45408-1445
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-0248
  • Fax: 937-228-0247
Mailing address:
  • Phone: 937-228-0248
  • Fax: 937-228-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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