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General NPI Number Information
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NPI Number | 1144382094
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Entity Type | Organization
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Legal Business Name | WHITE ROCK ENT PA
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 1130 BEACHVIEW ST SUITE 240
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City | DALLAS
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State | TX
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Zip | 75218-4624
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Country | US
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Telephone | 214-324-0418
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Fax | 214-324-0693
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Provider Business Mailing Address
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Address Line | 1130 BEACHVIEW ST SUITE 240
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City | DALLAS
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State | TX
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Zip | 75218-4624
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Country | US
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Telephone | 214-324-0418
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Fax | 214-324-0693
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Authorized Official
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Title or Position | PARTNER
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Name | MR. DWIGHT AUGUSTUS LEE
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Credential | M.D.
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Telephone | 214-324-0418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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