Provider Demographics
NPI:1295222180
Name:DFW ORTHOTICS AND PROSTHETICS, LLC
Entity Type:Organization
Organization Name:DFW ORTHOTICS AND PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PHUOC
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPO, CPO
Authorized Official - Phone:214-325-7639
Mailing Address - Street 1:1721 W PLANO PKWY STE 212
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-8600
Mailing Address - Country:US
Mailing Address - Phone:214-325-7639
Mailing Address - Fax:
Practice Address - Street 1:1721 W PLANO PKWY STE 212
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-8600
Practice Address - Country:US
Practice Address - Phone:214-325-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DFW ORTHOTICS AND PROSTHETICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier