Provider Demographics
NPI:1295074557
Name:NDL DALLAS HOLDINGS, LLC
Entity type:Organization
Organization Name:NDL DALLAS HOLDINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-424-4450
Mailing Address - Street 1:6510 ABRAMS RD
Mailing Address - Street 2:STE 510
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7217
Mailing Address - Country:US
Mailing Address - Phone:214-363-3623
Mailing Address - Fax:214-363-0869
Practice Address - Street 1:6510 ABRAMS RD
Practice Address - Street 2:STE 510
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7217
Practice Address - Country:US
Practice Address - Phone:214-363-3623
Practice Address - Fax:214-363-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory