Provider Demographics
NPI:1699573253
Name:ADETON MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ADETON MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGHODARO
Authorized Official - Middle Name:O
Authorized Official - Last Name:AMAYAEVBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-577-7690
Mailing Address - Street 1:9535 FOREST LN STE 125B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5900
Mailing Address - Country:US
Mailing Address - Phone:214-792-9009
Mailing Address - Fax:
Practice Address - Street 1:9535 FOREST LN STE 125B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-5900
Practice Address - Country:US
Practice Address - Phone:214-792-9009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies