Organization
DIXIE A. FULLERTON
Active
Other names
Superior Limb & Brace Company
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIXIE A FULLERTON (OWNER)
(702) 382-8287
Entity
Organization
Contact information
Practice address
1621 FREMONT ST, LAS VEGAS, NV 89101-5413
(702) 382-8287
(702) 388-0727
Mailing address
1621 FREMONT ST, LAS VEGAS, NV 89101-5413
(702) 382-8287
(702) 388-0727
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003302875
—
NV
Enumeration date
01/05/2007
Last updated
07/23/2012
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