Healthcare Provider Details

I. General information

NPI: 1164699237
Provider Name (Legal Business Name): SULE FACIAL PLASTIC SURGERY CLINIC,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 MERIT DR SUITE 1060
DALLAS TX
75251-2202
US

IV. Provider business mailing address

12221 MERIT DR SUITE 1060
DALLAS TX
75251-2202
US

V. Phone/Fax

Practice location:
  • Phone: 972-960-2950
  • Fax: 972-960-2838
Mailing address:
  • Phone: 972-960-2950
  • Fax: 972-960-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberM4570
License Number StateTX

VIII. Authorized Official

Name: DR. SANDEEP SULE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-960-2950