# SPECIALTY FACIAL PROSTHETICS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** SPECIALTY FACIAL PROSTHETICS, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912665076
- **Legal business name:** SPECIALTY FACIAL PROSTHETICS, LLC
- **Authorized official:** CHARLESETTA MARIA THOMPSON (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (405) 595-3226

## Contact information

- **Practice address:** 214 E LUMSDEN RD, BRANDON, FL 33511-6440
- **Practice address phone:** (813) 684-1142
- **Practice address fax:** (813) 681-0921
- **Mailing address:** 229 NW 9TH ST, OKLAHOMA CITY, OK 73102-2619
- **Mailing address phone:** (405) 595-3226
- **Mailing address fax:** (405) 600-6296

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 12/06/2021
- **Last updated:** 12/06/2021