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General NPI Number Information
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NPI Number | 1063192896
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Entity Type | Organization
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Legal Business Name | PERIDOT VENTURES LLC
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 2721 SHORELINE DR STE 120
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City | DENTON
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State | TX
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Zip | 76210-0170
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Country | US
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Telephone | 469-648-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 900 S PRESTON RD STE 50-116
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City | PROSPER
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State | TX
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Zip | 75078-5143
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Country | US
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Telephone | 972-895-3456
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | QUANIQUE JOHNSON
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Credential |
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Telephone | 972-895-3456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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