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General NPI Number Information
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NPI Number | 1033397062
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Entity Type | Organization
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Legal Business Name | DFW SURGICAL SOLUTIONS LLC
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 2521 LONE STAR LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-4535
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Country | US
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Telephone | 817-480-1800
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Fax | 817-251-0205
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Provider Business Mailing Address
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Address Line | PO BOX 186
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City | GRAPEVINE
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State | TX
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Zip | 76099-0186
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Country | US
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Telephone | 817-480-1800
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Fax | 817-251-0205
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | DR. JACKIE DEAN BONNER II
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Credential | DC
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Telephone | 817-480-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SM0705X
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Taxonomy Name | Medical-Surgical Clinical Nurse Specialist
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License Number | 537082/686090
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License Number State | TX
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