Basic Information
| Provider Information | |||||||||
| NPI: | 1386846988 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAYTON | ||||||||
| FirstName: | MINDI | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3720 N ANKENY BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500234619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156393775 | ||||||||
| FaxNumber: | 5159643012 | ||||||||
| Practice Location | |||||||||
| Address1: | 3720 N ANKENY BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | ANKENY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 500234619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5156393775 | ||||||||
| FaxNumber: | 5159643012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 02/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 00784 | IA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 1386846988 | 05 | IA | MEDICAID |