Provider Demographics
NPI:1437256187
Name:DUDASH, JOSEPH GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GREGORY
Last Name:DUDASH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PLACE
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-6115
Mailing Address - Country:US
Mailing Address - Phone:937-762-1306
Mailing Address - Fax:937-522-7626
Practice Address - Street 1:500 LINCOLN PARK BLVD STE 220
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6404
Practice Address - Country:US
Practice Address - Phone:937-294-4487
Practice Address - Fax:937-294-2255
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049342D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0581231Medicaid
OH2712872Medicaid
OH2712872Medicaid
OHA81976Medicare UPIN
OHDUO565202Medicare ID - Type Unspecified