Healthcare Provider Details

I. General information

NPI: 1679567317
Provider Name (Legal Business Name): DULEMBA AND MANTRI MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3321 UNICORN LAKE BLVD SUITE 121
DENTON TX
76210-0106
US

IV. Provider business mailing address

3321 UNICORN LAKE BLVD SUITE 121
DENTON TX
76210-0106
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-6248
  • Fax: 940-381-1881
Mailing address:
  • Phone: 940-387-6248
  • Fax: 940-381-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUHAS MANTRI
Title or Position: OWNER
Credential: MD
Phone: 940-387-6248