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General NPI Number Information
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NPI Number | 1134427206
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Entity Type | Organization
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Legal Business Name | TEXAS DERMATOLOGY AND SKIN CANCER CENTER, PLLC
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 3142 HORIZON RD SUITE 201
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City | ROCKWALL
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State | TX
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Zip | 75032-7809
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Country | US
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Telephone | 469-757-4410
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Fax | 469-277-3911
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Provider Business Mailing Address
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Address Line | 3142 HORIZON RD SUITE 201
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City | ROCKWALL
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State | TX
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Zip | 75032-7809
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Country | US
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Telephone | 469-757-4410
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Fax | 469-277-3911
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANJAY BHAMBRI
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Credential | DO
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Telephone | 469-757-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | N7906
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License Number State | TX
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