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General NPI Number Information
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NPI Number | 1073898748
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Entity Type | Organization
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Legal Business Name | ADVANCED TOXICOLOGY
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 1000 JOHNSON ST STE 3
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City | DENTON
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State | TX
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Zip | 76205-1211
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Country | US
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Telephone | 940-239-8806
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON ST STE 3
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City | DENTON
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State | TX
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Zip | 76205-1211
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Country | US
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Telephone | 940-239-8806
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ANGELA HOWARD
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Credential |
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Telephone | 940-442-1028
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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 | J6117
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License Number State | TX
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