Provider Demographics
NPI:1679686901
Name:DAYTON PREVENTIVE SERVICE
Entity Type:Organization
Organization Name:DAYTON PREVENTIVE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:RORRER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-277-4053
Mailing Address - Street 1:2599 NEEDMORE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414
Mailing Address - Country:US
Mailing Address - Phone:937-277-4053
Mailing Address - Fax:937-277-2943
Practice Address - Street 1:2599 NEEDMORE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414
Practice Address - Country:US
Practice Address - Phone:937-277-4053
Practice Address - Fax:937-277-2943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
9360941Medicare ID - Type Unspecified
H01216Medicare UPIN