Healthcare Provider Details

I. General information

NPI: 1679686901
Provider Name (Legal Business Name): DAYTON PREVENTIVE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2599 NEEDMORE RD
DAYTON OH
45414
US

IV. Provider business mailing address

2599 NEEDMORE RD
DAYTON OH
45414
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-4053
  • Fax: 937-277-2943
Mailing address:
  • Phone: 937-277-4053
  • Fax: 937-277-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK T RORRER
Title or Position: OWNER
Credential: DO
Phone: 937-277-4053