Provider Demographics
NPI:1578880795
Name:DEZARD SERVICES LLC
Entity Type:Organization
Organization Name:DEZARD SERVICES LLC
Other - Org Name:AFFORDABLE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEZARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-273-0802
Mailing Address - Street 1:13478 69TH ST N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1921
Mailing Address - Country:US
Mailing Address - Phone:561-729-1541
Mailing Address - Fax:
Practice Address - Street 1:6700 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-7544
Practice Address - Country:US
Practice Address - Phone:954-961-0472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies