Healthcare Provider Details

I. General information

NPI: 1598912115
Provider Name (Legal Business Name): DENTON PAIN MANAGEMENT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 COLORADO BLVD
DENTON TX
76210
US

IV. Provider business mailing address

3201 COLORADO BLVD
DENTON TX
76210
US

V. Phone/Fax

Practice location:
  • Phone: 954-835-0005
  • Fax: 954-472-8271
Mailing address:
  • Phone: 954-835-0005
  • Fax: 954-472-8271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number007828
License Number StateTX

VIII. Authorized Official

Name: MR. VINCENT MONTELIONE
Title or Position: PRESIDENT
Credential:
Phone: 954-608-3737