Individual
MARIA TERASA VAN DYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2269 S DIXIE DR, KETTERING, OH 45409-2018
(937) 723-0112
Mailing address
1405 PHILLIPS AVE, DAYTON, OH 45410-2638
(937) 723-0112
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
251X00000X
OH
Other
Enumeration date
12/18/2023
Last updated
12/18/2023
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