Provider Demographics
NPI:1487368452
Name:DEDMON HOLDINGS LLC
Entity type:Organization
Organization Name:DEDMON HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEDMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-786-4663
Mailing Address - Street 1:1846 E ROSEMEADE PKWY STE 1150
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2570 LAKE RIDGE RD APT 4212
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4966
Practice Address - Country:US
Practice Address - Phone:469-325-1663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-13
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment