Healthcare Provider Details

I. General information

NPI: 1790352912
Provider Name (Legal Business Name): DEGA ULTRASOUND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 COLORADO BLVD STE 102
DENTON TX
76210-6889
US

IV. Provider business mailing address

PO BOX 111307
CARROLLTON TX
75011-1307
US

V. Phone/Fax

Practice location:
  • Phone: 950-566-6666
  • Fax: 940-387-3692
Mailing address:
  • Phone: 207-768-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERIKA JANICE JOHLER
Title or Position: LEAD TECH/OWNER
Credential: RDCS
Phone: 207-768-1479