Organization
DSA108 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRABHAV TELLA (OWNER)
(214) 620-7444
Entity
Organization
Contact information
Practice address
108 SAN GABRIEL DR, IRVING, TX 75039-3350
(214) 620-7444
Mailing address
825 W ROYAL LN, STE 230, IRVING, TX 75039-3601
(214) 620-7444
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
04/24/2015
Last updated
04/24/2015
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