Provider Demographics
NPI:1477793156
Name:DAYTON HEAD AND NECK SURGEONS
Entity Type:Organization
Organization Name:DAYTON HEAD AND NECK SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-496-2600
Mailing Address - Street 1:369 W 1ST ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-3065
Mailing Address - Country:US
Mailing Address - Phone:937-496-2620
Mailing Address - Fax:937-496-2610
Practice Address - Street 1:369 W 1ST ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-3065
Practice Address - Country:US
Practice Address - Phone:937-496-2600
Practice Address - Fax:937-496-2610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212203163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000606049OtherANTHEM