Healthcare Provider Details

I. General information

NPI: 1154022333
Provider Name (Legal Business Name): DFW DERMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 STONEMEADE WAY
COPPELL TX
75019-2679
US

IV. Provider business mailing address

5495 DENTON DR APT 4103
DALLAS TX
75235-7662
US

V. Phone/Fax

Practice location:
  • Phone: 214-300-9680
  • Fax: 972-279-1102
Mailing address:
  • Phone: 214-300-9680
  • Fax: 972-279-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: UZOAMAKA UKOHA
Title or Position: OWNER
Credential:
Phone: 214-300-9680