Individual
KENTORIA TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4245 N CENTRAL EXPY STE 490, DALLAS, TX 75205-4231
(469) 245-6831
Mailing address
4245 N CENTRAL EXPY STE 490, DALLAS, TX 75205-4231
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
TX
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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