=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326971185
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLASTIC SURGERY PHYSICIAN ASSISTANTS OF TEXAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2026
-----------------------------------------------------
Last Update Date | 06/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8220 WALNUT HILL LN STE 206
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75231-4406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-739-5760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 671192
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75367-1192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-739-5760
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SHAREHOLDER
-----------------------------------------------------
Name | FADI CONSTANTINE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-500-8685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------