Healthcare Provider Details

I. General information

NPI: 1720051212
Provider Name (Legal Business Name): DAVID C. DYSLIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W INTERSTATE 20 STE. 212
ARLINGTON TX
76017-5870
US

IV. Provider business mailing address

811 W INTERSTATE 20 STE. 212
ARLINGTON TX
76017-5870
US

V. Phone/Fax

Practice location:
  • Phone: 817-275-3309
  • Fax: 817-275-0071
Mailing address:
  • Phone: 817-275-3309
  • Fax: 817-275-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberJ9667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: