Organization
DGB SUPPORT ENT
Active
Organization
DGB SUPPORT ENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS BENJAMIN (PROGRAM MANAGER)
(817) 534-4448
Entity
Organization
Contact information
Practice address
2320 BLUE SMOKE CT N, FORT WORTH, TX 76105-1003
(817) 534-4448
Mailing address
2320 BLUE SMOKE CT N, FORT WORTH, TX 76105-1003
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
—
Other
Enumeration date
10/31/2011
Last updated
10/31/2011
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