Provider Demographics
NPI:1871188060
Name:SMALLWOOD, DALE LEON
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:LEON
Last Name:SMALLWOOD
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 1:13633 STATE ROUTE 56
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45644-9683
Mailing Address - Country:US
Mailing Address - Phone:740-637-0427
Mailing Address - Fax:
Practice Address - Street 1:13633 STATE ROUTE 56
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OH
Practice Address - Zip Code:45644-9683
Practice Address - Country:US
Practice Address - Phone:740-637-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health