Provider Demographics
NPI:1619181021
Name:NORTH TEXAS DISPENSERS
Entity Type:Organization
Organization Name:NORTH TEXAS DISPENSERS
Other - Org Name:NORTH TEXAS DISPENSERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER HEARING AID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:B
Authorized Official - Last Name:LARDIZABAL
Authorized Official - Suffix:
Authorized Official - Credentials:BC HIS ACA BOARD CER
Authorized Official - Phone:940-387-9574
Mailing Address - Street 1:1421 N ELM
Mailing Address - Street 2:#105
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201
Mailing Address - Country:US
Mailing Address - Phone:940-387-9574
Mailing Address - Fax:940-387-5502
Practice Address - Street 1:1421 N ELM
Practice Address - Street 2:#105
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201
Practice Address - Country:US
Practice Address - Phone:940-387-9574
Practice Address - Fax:940-387-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50053174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519 070OtherBLUE CROSS BLUE SHIELD
TX519 070OtherBLUE CROSS BLUE SHIELD