Healthcare Provider Details

I. General information

NPI: 1265368229
Provider Name (Legal Business Name): SD DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S FREDERICK AVE APT 319
GAITHERSBURG MD
20877-6313
US

IV. Provider business mailing address

550 S FREDERICK AVE APT 319
GAITHERSBURG MD
20877-6313
US

V. Phone/Fax

Practice location:
  • Phone: 405-444-7858
  • Fax:
Mailing address:
  • Phone: 405-444-7858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DIXON WILSON
Title or Position: SOLE MBR
Credential:
Phone: 405-444-7858