Healthcare Provider Details

I. General information

NPI: 1598548257
Provider Name (Legal Business Name): WARTHAN DERMATOLOGY DALLAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 COIT RD STE 200
DALLAS TX
75251-2302
US

IV. Provider business mailing address

5751 EDWARDS RANCH RD STE 101
FORT WORTH TX
76109-4131
US

V. Phone/Fax

Practice location:
  • Phone: 817-923-8220
  • Fax:
Mailing address:
  • Phone: 817-923-8220
  • Fax: 817-923-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JACLYN HILL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 817-923-8220