MEDICARE: DAFONTE MEDICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier	000125	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568456937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAFONTE MEDICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	1101 HIGHWAY 6 S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1021
Country	:	US
Telephone Number	:	281-498-3566
Fax Number	:	281-498-5388

Provider Business Practice Location Address
First Line	:	1101 HIGHWAY 6 S
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1021
Country	:	US
Telephone Number	:	281-498-3566
Fax Number	:	281-498-5388

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BRANDEE NICOLA DAFONTE
Credential	:
Telephone Number	:	281-498-3566

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	06/01/2011

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Directions to “DAFONTE MEDICAL SERVICES, LLC ” Practice Location

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