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Organization
SPECIALTY FACIAL PROSTHETICS LLC
Active
Organization
SPECIALTY FACIAL PROSTHETICS LLC
Active
Parent organization
SPECIALTY FACIAL PROSTHETICS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPECIALTY FACIAL PROSTHETICS, LLC
Authorized official
CHARLESETTA MARIA THOMPSON (AUTHORIZED OFFICIAL)
(405) 595-3226
Entity
Organization
Contact information
Practice address
214 E LUMSDEN RD, BRANDON, FL 33511-6440
(813) 684-1142
(813) 681-0921
Mailing address
229 NW 9TH ST, OKLAHOMA CITY, OK 73102-2619
(405) 595-3226
(405) 600-6296
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NULL
Other
Enumeration date
12/06/2021
Last updated
12/06/2021
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