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General NPI Number Information
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NPI Number | 1043580616
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Entity Type | Organization
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Legal Business Name | DRA HEALTH SERVICES OF TEXAS
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Dates
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Enumeration Date | 01/12/2012
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Last Update Date | 01/12/2012
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Provider Practice Location Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120-210
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6634
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Country | US
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Telephone | 800-584-1671
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Fax | 817-745-1232
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Provider Business Mailing Address
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Address Line | 2600 E SOUTHLAKE BLVD STE 120-210
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6634
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Country | US
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Telephone | 800-584-1671
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Fax | 817-745-1232
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Authorized Official
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Title or Position | OWNER - PRESIDENT
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Name | MR. ALLEN GRANT
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Credential |
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Telephone | 214-783-6769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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