Provider Demographics
NPI:1629580667
Name:DAYTON-DANDES CENTER FOR INTEGRATIVE MEDICINE LLC
Entity Type:Organization
Organization Name:DAYTON-DANDES CENTER FOR INTEGRATIVE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-931-8484
Mailing Address - Street 1:18600 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2426
Mailing Address - Country:US
Mailing Address - Phone:305-931-8484
Mailing Address - Fax:
Practice Address - Street 1:18600 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2426
Practice Address - Country:US
Practice Address - Phone:305-931-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care