Healthcare Provider Details

I. General information

NPI: 1376921734
Provider Name (Legal Business Name): TRINITY PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W COLORADO BLVD STE 441
DALLAS TX
75208-2312
US

IV. Provider business mailing address

PO BOX 674074
DALLAS TX
75267-4074
US

V. Phone/Fax

Practice location:
  • Phone: 214-396-3936
  • Fax: 214-378-4664
Mailing address:
  • Phone: 214-396-3936
  • Fax: 214-378-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MISS BRANDY K BARROW
Title or Position: TRANSACTION POSTER
Credential:
Phone: 214-396-3936