Provider Demographics
NPI:1982756482
Name:ZIDAR, DAVID A (LISW-S)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:ZIDAR
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 PARK CREEK DR
Mailing Address - Street 2:NE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-5165
Mailing Address - Country:US
Mailing Address - Phone:330-651-5253
Mailing Address - Fax:
Practice Address - Street 1:7750 PARK CREEK DR
Practice Address - Street 2:NE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-5165
Practice Address - Country:US
Practice Address - Phone:330-651-5253
Practice Address - Fax:330-772-0472
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0008005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000386573OtherATHEM HEALTH CARE