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General NPI Number Information
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NPI Number | 1164549887
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Entity Type | Organization
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Legal Business Name | GENECOV PLASTIC SURGERY GROUP, PA
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 7777 FOREST LN STE C528
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City | DALLAS
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State | TX
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Zip | 75230-6848
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Country | US
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Telephone | 972-331-1900
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Fax | 972-331-1909
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN STE C528
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City | DALLAS
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State | TX
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Zip | 75230-6848
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Country | US
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Telephone | 972-331-1900
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Fax | 972-331-1909
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. JULI SMIDDY
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Credential |
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Telephone | 972-331-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 19138
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | NA
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License Number State | TX
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