Healthcare Provider Details

I. General information

NPI: 1558478149
Provider Name (Legal Business Name): DAYTON PAIN AND PREVENTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 NEEDMORE RD
DAYTON OH
45414
US

IV. Provider business mailing address

2595 NEEDMORE RD
DAYTON OH
45414
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-3442
  • Fax: 937-277-2943
Mailing address:
  • Phone: 937-277-3442
  • Fax: 937-277-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P MOORE III
Title or Position: MD OWNER SOLE PARTNER
Credential: ND
Phone: 937-277-3442