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General NPI Number Information
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NPI Number | 1891799292
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Entity Type | Organization
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Legal Business Name | MILLER BRACE CO., INC.
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 3902 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-1511
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Country | US
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Telephone | 214-824-4507
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Fax | 214-824-7553
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Provider Business Mailing Address
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Address Line | 3902 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-1511
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Country | US
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Telephone | 214-824-4507
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Fax | 214-824-7553
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MRS. JANET D NEVIL
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Credential | L.O.
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Telephone | 214-824-4507
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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 | 000129
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License Number State | TX
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