1487080784 NPI number — THE DREAM IN COLOR GROUP

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 1487080784 NPI number — THE DREAM IN COLOR GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE DREAM IN COLOR GROUP
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:
6
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:
1487080784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2378 E LEDBETTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75216-7410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-985-7801
Provider Business Mailing Address Fax Number:
800-985-7801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 COMMERCE ST
Provider Second Line Business Practice Location Address:
SUITE 660
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75201-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-985-7801
Provider Business Practice Location Address Fax Number:
800-985-7801
Provider Enumeration Date:
09/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
18009857801

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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