Healthcare Provider Details

I. General information

NPI: 1568288926
Provider Name (Legal Business Name): DYNAMO DNA SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2024
Last Update Date: 12/02/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17250 DALLAS PKWY
DALLAS TX
75248-1136
US

IV. Provider business mailing address

17250 DALLAS PKWY
DALLAS TX
75248-1136
US

V. Phone/Fax

Practice location:
  • Phone: 469-209-1055
  • Fax:
Mailing address:
  • Phone: 469-209-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE MITCHELL
Title or Position: DIRECTOE
Credential:
Phone: 469-833-8076