Organization
ANGEL HEART CRANIAL PROSTHESIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FAIRY LLOYD (OWNER)
(314) 562-3698
Entity
Organization
Contact information
Practice address
8500 N STEMMONS FWY # 3021, DALLAS, TX 75247-3832
(502) 381-1983
Mailing address
2612 RED OAK DR, LITTLE ELM, TX 75068-5719
(502) 381-1983
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/20/2023
Last updated
09/22/2023
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