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General NPI Number Information
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NPI Number | 1114479466
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Entity Type | Organization
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Legal Business Name | DYNAMIC SURGICAL ASSISTANTS OF TEXAS
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Dates
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Enumeration Date | 11/02/2016
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Last Update Date | 11/02/2016
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Provider Practice Location Address
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Address Line | 2503 ROBIN KNOLL CT
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City | FRESNO
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State | TX
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Zip | 77545-8167
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Country | US
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Telephone | 281-509-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 2503 ROBIN KNOLL CT
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City | FRESNO
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State | TX
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Zip | 77545-8167
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Country | US
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Telephone | 281-509-2017
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Fax |
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Authorized Official
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Title or Position | LICENSED SURGICAL ASSISTANT
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Name | KEITH WILSON
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Credential | LSA
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Telephone | 281-509-2017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA00410
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License Number State | TX
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