Provider Demographics
NPI:1245347285
Name:DALTON & VAN FOSSEN SURGEONS INC
Entity type:Organization
Organization Name:DALTON & VAN FOSSEN SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-564-2438
Mailing Address - Street 1:95 ARCH ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1437
Mailing Address - Country:US
Mailing Address - Phone:330-564-2438
Mailing Address - Fax:330-564-2443
Practice Address - Street 1:95 ARCH ST
Practice Address - Street 2:SUITE 280
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1437
Practice Address - Country:US
Practice Address - Phone:330-564-2438
Practice Address - Fax:330-564-2443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064327174400000X
OH35062167D174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty