Healthcare Provider Details

I. General information

NPI: 1457784118
Provider Name (Legal Business Name): IHEART PRACTICE DENTON PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 COLORADO BLVD STE 202
DENTON TX
76210-6871
US

IV. Provider business mailing address

885 E COLLINS BLVD STE 109
RICHARDSON TX
75081-2270
US

V. Phone/Fax

Practice location:
  • Phone: 214-253-0391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID W TAYCE
Title or Position: MANAGER
Credential:
Phone: 214-244-9820