MEDICARE: DERMATOLOGY CARE CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1770727844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY CARE CENTER

Provider Business Mailing Address
First Line	:	17194 PRESTON RD
Second Line	:	SUITE 102
City	:	DALLAS
State	:	TX
Zip	:	75248-1221
Country	:	US
Telephone Number	:	214-432-4387
Fax Number	:	866-886-2083

Provider Business Practice Location Address
First Line	:	7712 SAN JACINTO PL
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75024-3257
Country	:	US
Telephone Number	:	214-432-4387
Fax Number	:	866-886-2083

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MOBOLAJI OPEOLA
Credential	:	M.D.,
Telephone Number	:	214-432-4387

Provider Enumeration Date	:	04/20/2009
Last Update Date	:	04/20/2009

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Directions to “DERMATOLOGY CARE CENTER ” Practice Location

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