1881099315 NPI number — HIGHLAND DERMATOLOGY AND PLASTIC SURGERY CENTER LLC

Table of content: (NPI 1881099315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881099315 NPI number — HIGHLAND DERMATOLOGY AND PLASTIC SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIGHLAND DERMATOLOGY AND PLASTIC SURGERY CENTER LLC
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:
1881099315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10743 PRESTON RD
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:
75230-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-905-5075
Provider Business Mailing Address Fax Number:
214-905-0903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3607 OAK LAWN AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-4311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-905-5075
Provider Business Practice Location Address Fax Number:
214-905-0903
Provider Enumeration Date:
10/27/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TITTLE
Authorized Official First Name:
BEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-905-5075

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  F7235 , 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)

  • Identifier: 1699851923 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com