Provider Demographics
NPI:1659088615
Name:DUMMITT, IVAN DALE III
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:DALE
Last Name:DUMMITT
Suffix:III
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 1:96 PRIVATE DRIVE 1277
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8740
Mailing Address - Country:US
Mailing Address - Phone:502-644-6056
Mailing Address - Fax:
Practice Address - Street 1:202 PARK AVE APT 407
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1557
Practice Address - Country:US
Practice Address - Phone:740-533-7199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant