Executive de-Tails

Primary specialty

ContractorTaxonomy code 171W00000X

Legal business name

EXECUTIVE DE-TAILS

Practice address

2952 Celian Dr
Grand Prairie, TX 75052-8737

Phone

(817) 247-5267

NPI assigned

Dec 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mark Aidelojie

Title

Consultant

Phone

(817) 274-2284

Specialties & licenses 1

Addresses

Other names 1

• Executive De-Tails Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629134440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2952 CELIAN DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750528737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2952 CELIAN DR",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750528737",
            "telephone_number": "817-247-5267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE DE-TAILS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "AIDELOJIE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CONSULTANT",
        "authorized_official_telephone_number": "817-274-2284",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Executive De-Tails",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Contractor in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Contractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.