1477783330 NPI number — NORTH DALLAS PLASTIC SURGERY ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477783330 NPI number — NORTH DALLAS PLASTIC SURGERY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH DALLAS PLASTIC SURGERY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477783330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8305 WALNUT HILL LN
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-4217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-509-0270
Provider Business Mailing Address Fax Number:
214-363-3665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1105 CENTRAL EXPWY N
Provider Second Line Business Practice Location Address:
SUITE 2310
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013-6115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-363-2575
Provider Business Practice Location Address Fax Number:
214-363-3665
Provider Enumeration Date:
07/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
POLLOCK
Authorized Official First Name:
TODD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-509-0270

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  J0205 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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