Provider Demographics
NPI:1497342612
Name:GINGRICH, DENTON JAMES
Entity Type:Individual
Prefix:
First Name:DENTON
Middle Name:JAMES
Last Name:GINGRICH
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 1:1608 TURFLAND BLVD S
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-7030
Mailing Address - Country:US
Mailing Address - Phone:937-509-7933
Mailing Address - Fax:
Practice Address - Street 1:1608 TURFLAND BLVD S
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-7030
Practice Address - Country:US
Practice Address - Phone:937-509-7933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.20057011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical