# DSA108 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710374046
- **Authorized official:** PRABHAV TELLA (OWNER)
- **Authorized official phone:** (214) 620-7444

## Contact information

- **Practice address:** 108 SAN GABRIEL DR, IRVING, TX 75039-3350
- **Practice address phone:** (214) 620-7444
- **Mailing address:** 825 W ROYAL LN, STE 230, IRVING, TX 75039-3601
- **Mailing address phone:** (214) 620-7444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2015
- **Last updated:** 04/24/2015