Organization
DYNAMIC X-RAY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENNY J. ILLICKAL (OWNER)
(972) 352-7260
Entity
Organization
Contact information
Practice address
4230 LBJ FWY, STE, 111, DALLAS, TX 75244-5806
(972) 352-7260
Mailing address
291 STONE MOUNTAIN DR, SUNNYVALE, TX 75182-2655
(972) 352-7260
Taxonomy
Speciality
Code
Description
License number
State
246XS1301X
Sonography Specialist/Technologist Cardiovascular
—
TX
247100000X
Radiologic Technologist
Primary
—
TX
2471C3402X
Radiography Radiologic Technologist
—
TX
2471S1302X
Sonography Radiologic Technologist
—
TX
2471V0105X
Vascular Sonography Radiologic Technologist
—
TX
Other
Enumeration date
09/23/2014
Last updated
06/20/2018
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