Healthcare Provider Details

I. General information

NPI: 1053971176
Provider Name (Legal Business Name): JESSICA DABIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 DALLAS PKWY
FRISCO TX
75034-9580
US

IV. Provider business mailing address

5700 DALLAS PKWY
FRISCO TX
75034-9580
US

V. Phone/Fax

Practice location:
  • Phone: 469-515-7158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number1280585
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: