Provider Demographics
NPI:1093566440
Name:DUNHAM, RILEY ISAAC
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:ISAAC
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 E MIAMI
Practice Address - Street 2:
Practice Address - City:DEGRAFF
Practice Address - State:OH
Practice Address - Zip Code:43318
Practice Address - Country:US
Practice Address - Phone:937-508-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker