Organization
MALE REPRODUCTIVE MEDICINE OF SOUTHWEST OHIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENI R BENNETT (CREDENTIALING MANAGER)
(937) 435-6136
Entity
Organization
Contact information
Practice address
5692 FAR HILLS AVE, KETTERING, OH 45429-2239
(937) 434-9901
(937) 434-9107
Mailing address
2773 ORCHARD RUN RD, DAYTON, OH 45449-2831
(937) 435-3110
(937) 435-6135
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
35-086518
OH
Other
Enumeration date
09/16/2006
Last updated
06/20/2008
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