Healthcare Provider Details

I. General information

NPI: 1437256187
Provider Name (Legal Business Name): JOSEPH GREGORY DUDASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LINCOLN PARK BLVD STE 220
KETTERING OH
45429-6404
US

IV. Provider business mailing address

1 PRESTIGE PLACE SUITE 550
MIAMISBURG OH
45342-6115
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-4487
  • Fax: 937-294-2255
Mailing address:
  • Phone: 937-762-1306
  • Fax: 937-522-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35049342D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: