Healthcare Provider Details

I. General information

NPI: 1104958768
Provider Name (Legal Business Name): DAYTON PEDIATRIC UROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ UROLOGY
DAYTON OH
45404-1898
US

IV. Provider business mailing address

1 CHILDRENS PLZ UROLOGY
DAYTON OH
45404-1898
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3466
  • Fax: 937-641-4600
Mailing address:
  • Phone: 937-641-3466
  • Fax: 937-641-4600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNN A BUFFINGTON
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 937-429-7196