Healthcare Provider Details

I. General information

NPI: 1366880080
Provider Name (Legal Business Name): FRISCO ENT FOR CHILDREN, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 06/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11445 DALLAS PKWY SUITE 240
FRISCO TX
75033-4255
US

IV. Provider business mailing address

783 N DENTON TAP RD SUITE 200
COPPELL TX
75019-2169
US

V. Phone/Fax

Practice location:
  • Phone: 972-315-2005
  • Fax:
Mailing address:
  • Phone: 972-745-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANNA J MOORE
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMPE
Phone: 972-745-8400