Healthcare Provider Details

I. General information

NPI: 1740475813
Provider Name (Legal Business Name): MACAIRA DYMENT D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9759 FAIRWAY BLVD
POWELL OH
43065-6947
US

IV. Provider business mailing address

PO BOX 1554
REYNOLDSBURG OH
43068-6554
US

V. Phone/Fax

Practice location:
  • Phone: 614-792-3668
  • Fax: 614-792-7615
Mailing address:
  • Phone: 614-864-9560
  • Fax: 614-864-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36-003549
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: