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General NPI Number Information
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NPI Number | 1043873326
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Entity Type | Organization
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Legal Business Name | PEDIATRIC NEUROLOGY OF DALLAS
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 04/22/2019
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Provider Practice Location Address
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Address Line | 7777 FOREST LANE MEDICAL CITY DALLAS SUITE A-234
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City | DALLAS
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State | TX
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Zip | 75230-2507
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Country | US
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Telephone | 972-566-5656
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Fax | 972-566-5627
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Provider Business Mailing Address
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Address Line | 7777 FOREST LANE MEDICAL CITY DALLAS SUITE B-248
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City | DALLAS
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State | TX
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Zip | 75230-2507
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Country | US
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Telephone | 972-566-8600
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Fax | 972-566-8601
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MRS. MAHSHID MOEIN
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Credential | M.D.
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Telephone | 214-707-8121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number |
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License Number State |
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