Organization Name: | DALLAS AVENUE DENTAL CARE, INC. |
NPI Number: | 1255769535 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DIANE MAROSY (OWNER) |
Mailing Address: | 400 Pine Ave Mena |
State: | AR US |
Postal Code: | 719534604 |
Phone Number: | 4793947800 |
Fax Number: | 4793947803 |
NPI Enumeration Date: | 10/23/2013 |
NPI Last Update Date: | 10/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 2933 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |