1558114827 NPI number — BEHAVIORAL HEALTH SERVICES OF DAYTON LLC

Table of content: DR. JOSE DUMERGUE DOMINGUEZ DDS (NPI 1992838304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558114827 NPI number — BEHAVIORAL HEALTH SERVICES OF DAYTON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEHAVIORAL HEALTH SERVICES OF DAYTON LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558114827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 N FEDERAL HWY STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33460-3493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-812-9652
Provider Business Mailing Address Fax Number:
833-535-0164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8130 MILLER FARM LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45458-7301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-812-9652
Provider Business Practice Location Address Fax Number:
833-535-0164
Provider Enumeration Date:
04/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
JARED
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
772-812-9652

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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