Organization
RSS DAIN PAXTON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATISHA PEOPLES (CREDENTIALING SPECIALIST)
(817) 440-6060
Entity
Organization
Contact information
Practice address
9735 SW SHADY LN STE 201, TIGARD, OR 97223-5481
(817) 440-6060
(469) 778-6114
Mailing address
1050 TEXAN TRL STE 300, GRAPEVINE, TX 76051-3759
(817) 440-6060
(469) 778-6114
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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