Healthcare Provider Details

I. General information

NPI: 1447757745
Provider Name (Legal Business Name): RSS DAIN PAXTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 SW SHADY LN STE 201
TIGARD OR
97223-5481
US

IV. Provider business mailing address

1050 TEXAN TRL STE 300
GRAPEVINE TX
76051-3759
US

V. Phone/Fax

Practice location:
  • Phone: 817-440-6060
  • Fax: 469-778-6114
Mailing address:
  • Phone: 817-440-6060
  • Fax: 469-778-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: LATISHA PEOPLES
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 817-440-6060