Provider Demographics
NPI:1629856422
Name:RODDY, DAVID LARRY
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LARRY
Last Name:RODDY
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 1:7030 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2557
Mailing Address - Country:US
Mailing Address - Phone:937-367-1711
Mailing Address - Fax:937-388-8569
Practice Address - Street 1:7030 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2557
Practice Address - Country:US
Practice Address - Phone:937-367-1711
Practice Address - Fax:937-388-8569
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)