Provider Demographics
NPI:1972520880
Name:D & D ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:D & D ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DINAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-254-9292
Mailing Address - Street 1:1638 W IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7258
Mailing Address - Country:US
Mailing Address - Phone:972-254-9292
Mailing Address - Fax:972-254-9290
Practice Address - Street 1:1638 W IRVING BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7258
Practice Address - Country:US
Practice Address - Phone:972-254-9292
Practice Address - Fax:972-254-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX446335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1547242-01Medicaid
TX531355OtherBLUE CROSS BLUE SHIELD
TX1547242-01Medicaid