Provider Demographics
NPI:1699417139
Name:DAYTON KDC PLLC
Entity type:Organization
Organization Name:DAYTON KDC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-762-9992
Mailing Address - Street 1:225 MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1329
Mailing Address - Country:US
Mailing Address - Phone:423-428-9234
Mailing Address - Fax:423-428-9270
Practice Address - Street 1:225 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1329
Practice Address - Country:US
Practice Address - Phone:423-428-9234
Practice Address - Fax:423-428-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental