Healthcare Provider Details

I. General information

NPI: 1013953942
Provider Name (Legal Business Name): DENNIS J. PIERSON, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E ELM ST STE 240
LIMA OH
45804-2898
US

IV. Provider business mailing address

1220 E ELM ST STE 240
LIMA OH
45804-2898
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-9676
  • Fax: 419-227-9794
Mailing address:
  • Phone: 419-227-9676
  • Fax: 419-227-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-043987P
License Number StateOH

VIII. Authorized Official

Name: DENNIS J PIERSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-227-9676