Provider Demographics
NPI:1285232603
Name:DOMINIC DIPIERRO, DPM, LLC
Entity Type:Organization
Organization Name:DOMINIC DIPIERRO, DPM, LLC
Other - Org Name:BUCKEYE FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASSIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-532-8845
Mailing Address - Street 1:PO BOX 341689
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-1689
Mailing Address - Country:US
Mailing Address - Phone:937-637-8286
Mailing Address - Fax:937-736-2347
Practice Address - Street 1:5538 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3062
Practice Address - Country:US
Practice Address - Phone:937-637-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatricGroup - Single Specialty