Provider Demographics
NPI:1730532755
Name:DOMINIC DIPIERRO, DPM, LLC
Entity type:Organization
Organization Name:DOMINIC DIPIERRO, DPM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DIPIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:937-637-7994
Mailing Address - Street 1:PO BOX 341689
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434
Mailing Address - Country:US
Mailing Address - Phone:937-736-2299
Mailing Address - Fax:937-736-2347
Practice Address - Street 1:572 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9552
Practice Address - Country:US
Practice Address - Phone:937-637-7994
Practice Address - Fax:937-736-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-14
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003446213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty