1841294832 NPI number — NEW DAWN HEALTH CARE INC

Table of content: MR. LARRY EVERETT STIGALL DDS (NPI 1487762985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841294832 NPI number — NEW DAWN HEALTH CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW DAWN HEALTH CARE INC
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:
6
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:
1841294832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 E IRON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44622-2099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-343-5521
Provider Business Mailing Address Fax Number:
330-343-5526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 E IRON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44622-2099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-343-5521
Provider Business Practice Location Address Fax Number:
330-343-5526
Provider Enumeration Date:
06/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERSHBERGER
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
330-343-5521

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2515 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0305717 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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