Healthcare Provider Details

I. General information

NPI: 1942350244
Provider Name (Legal Business Name): DAYTON SURGEONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ELIZABETH PL SUITE 10A
DAYTON OH
45417-3445
US

IV. Provider business mailing address

1 ELIZABETH PL SUITE 10A
DAYTON OH
45417-3445
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-4126
  • Fax: 937-228-0247
Mailing address:
  • Phone: 937-228-4126
  • Fax: 937-228-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDRA J. HENNIGAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 937-228-4126