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General NPI Number Information
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NPI Number | 1598548257
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Entity Type | Organization
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Legal Business Name | WARTHAN DERMATOLOGY DALLAS LLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 12222 COIT RD STE 200
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City | DALLAS
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State | TX
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Zip | 75251-2302
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Country | US
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Telephone | 817-923-8220
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Fax |
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Provider Business Mailing Address
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Address Line | 5751 EDWARDS RANCH RD STE 101
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City | FORT WORTH
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State | TX
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Zip | 76109-4131
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Country | US
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Telephone | 817-923-8220
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Fax | 817-923-9004
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JACLYN HILL
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Credential |
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Telephone | 817-923-8220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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