Provider Demographics
NPI:1386068278
Name:BLUE DRAGON ROGUES, INC
Entity type:Organization
Organization Name:BLUE DRAGON ROGUES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-591-3028
Mailing Address - Street 1:3305 S. MAYHILL ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6054
Mailing Address - Country:US
Mailing Address - Phone:940-591-3028
Mailing Address - Fax:940-591-3029
Practice Address - Street 1:3305 S MAYHILL RD
Practice Address - Street 2:103
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6053
Practice Address - Country:US
Practice Address - Phone:940-591-3028
Practice Address - Fax:940-591-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment