Healthcare Provider Details

I. General information

NPI: 1386833374
Provider Name (Legal Business Name): DALLAS PEDIATRICS & INFECTIOUS DISEASE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S MAIN ST SUITE 100
GRAPEVINE TX
76051-5543
US

IV. Provider business mailing address

1120 S MAIN ST SUITE 100
GRAPEVINE TX
76051-5543
US

V. Phone/Fax

Practice location:
  • Phone: 817-416-5554
  • Fax: 817-416-5556
Mailing address:
  • Phone: 817-416-5554
  • Fax: 817-416-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK9784
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberK9784
License Number StateTX

VIII. Authorized Official

Name: DR. FARYAL ABDUL GHAFFAR
Title or Position: PRESIDENT
Credential: MD
Phone: 817-416-5554