Provider Demographics
NPI:1649032814
Name:D.A.B. MEDICAL, PLLC
Entity type:Organization
Organization Name:D.A.B. MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERSABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-748-2056
Mailing Address - Street 1:3045 RUE MICHELLE
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-8605
Mailing Address - Country:US
Mailing Address - Phone:210-748-2056
Mailing Address - Fax:
Practice Address - Street 1:1135 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3421
Practice Address - Country:US
Practice Address - Phone:228-875-6695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty