Provider Demographics
NPI:1114183555
Name:DAHL, DAVID NICHOLAS (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NICHOLAS
Last Name:DAHL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S STATE ROAD 57
Mailing Address - Street 2:STE A
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4371
Mailing Address - Country:US
Mailing Address - Phone:812-257-1052
Mailing Address - Fax:812-257-1061
Practice Address - Street 1:600 S STATE ROAD 57
Practice Address - Street 2:STE A
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4371
Practice Address - Country:US
Practice Address - Phone:812-257-1052
Practice Address - Fax:812-257-1061
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN11014487A207Q00000X
IN02003544A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine