Healthcare Provider Details

I. General information

NPI: 1639422108
Provider Name (Legal Business Name): PREFERRED PLASTIC SURGERY & SKIN CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 FAR HILLS AVE SUITE 110
DAYTON OH
45429-2382
US

IV. Provider business mailing address

5250 FAR HILLS AVE SUITE 110
DAYTON OH
45429-2382
US

V. Phone/Fax

Practice location:
  • Phone: 937-432-9810
  • Fax: 937-432-9815
Mailing address:
  • Phone: 937-432-9810
  • Fax: 937-432-9815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH ALLEN PERRINE
Title or Position: OWNER
Credential: M.D.
Phone: 937-554-7573