Provider Demographics
NPI:1740237452
Name:DAYTON EAR, NOSE & THROAT SURGEONS, INC.
Entity Type:Organization
Organization Name:DAYTON EAR, NOSE & THROAT SURGEONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAYES
Authorized Official - Last Name:BOYLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:937-434-0555
Mailing Address - Street 1:7076 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4281
Mailing Address - Country:US
Mailing Address - Phone:937-434-0555
Mailing Address - Fax:937-434-7413
Practice Address - Street 1:7076 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4281
Practice Address - Country:US
Practice Address - Phone:937-434-0555
Practice Address - Fax:937-434-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0198763Medicaid
OH0198763Medicaid