Healthcare Provider Details

I. General information

NPI: 1285777656
Provider Name (Legal Business Name): DENNIS AL BINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W MAIN ST
NEW LEBANON OH
45345-9172
US

IV. Provider business mailing address

550 W MAIN ST
NEW LEBANON OH
45345-9172
US

V. Phone/Fax

Practice location:
  • Phone: 937-687-1911
  • Fax: 937-687-1888
Mailing address:
  • Phone: 937-687-1911
  • Fax: 937-687-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35067795
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: