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General NPI Number Information
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NPI Number | 1346470663
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Entity Type | Organization
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Legal Business Name | CENTENNIAL LABORATORY, LLC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 03/15/2010
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Provider Practice Location Address
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Address Line | 3525 W FREDDY GONZALEZ DR SUITE B
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City | EDINBURG
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State | TX
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Zip | 78539-8544
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Country | US
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Telephone | 956-381-0440
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Fax | 956-381-0483
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Provider Business Mailing Address
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Address Line | 3525 W FREDDY GONZALEZ DR SUITE B
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City | EDINBURG
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State | TX
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Zip | 78539-8544
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Country | US
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Telephone | 956-381-0440
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Fax | 956-381-0483
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. WILLIAM K DABLAH JR.
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Credential | M.D.
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Telephone | 404-822-6845
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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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