Healthcare Provider Details

I. General information

NPI: 1285232603
Provider Name (Legal Business Name): DOMINIC DIPIERRO, DPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2020
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5538 PHILADELPHIA DR
DAYTON OH
45415-3062
US

IV. Provider business mailing address

PO BOX 341689
BEAVERCREEK OH
45434-1689
US

V. Phone/Fax

Practice location:
  • Phone: 937-637-7994
  • Fax:
Mailing address:
  • Phone: 937-637-8286
  • Fax: 937-736-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KASSIDY DIPIERRO
Title or Position: BILLING MANAGER
Credential:
Phone: 937-532-8845