Healthcare Provider Details

I. General information

NPI: 1235866765
Provider Name (Legal Business Name): DEANNE GROVES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 EVERGREEN AVE
DAYTON OH
45402-5514
US

IV. Provider business mailing address

523 EVERGREEN AVE
DAYTON OH
45402-5514
US

V. Phone/Fax

Practice location:
  • Phone: 937-608-8470
  • Fax:
Mailing address:
  • Phone: 937-608-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: