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General NPI Number Information
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NPI Number | 1568456937
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Entity Type | Organization
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Legal Business Name | DAFONTE MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 06/01/2011
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Provider Practice Location Address
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Address Line | 1101 HIGHWAY 6 S
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City | HOUSTON
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State | TX
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Zip | 77077-1021
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Country | US
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Telephone | 281-498-3566
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Fax | 281-498-5388
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Provider Business Mailing Address
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Address Line | 1101 HIGHWAY 6 S
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City | HOUSTON
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State | TX
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Zip | 77077-1021
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Country | US
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Telephone | 281-498-3566
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Fax | 281-498-5388
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BRANDEE NICOLA DAFONTE
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Credential |
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Telephone | 281-498-3566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 000125
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License Number State | TX
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