Provider Demographics
NPI:1437495934
Name:PHOENIX THERA-LASE SYSTEMS, LLC.
Entity Type:Organization
Organization Name:PHOENIX THERA-LASE SYSTEMS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND COO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:POWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-890-4054
Mailing Address - Street 1:5454 LA SIERRA DRIVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-2346
Mailing Address - Country:US
Mailing Address - Phone:469-567-3959
Mailing Address - Fax:
Practice Address - Street 1:5454 LA SIERRA DRIVE
Practice Address - Street 2:SUITE 203
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2346
Practice Address - Country:US
Practice Address - Phone:496-567-3959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty