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General NPI Number Information
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NPI Number | 1730308453
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Entity Type | Organization
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Legal Business Name | BREAST SURGEONS OF NORTH TEXAS
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7777 FOREST LN STE C614
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City | DALLAS
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State | TX
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Zip | 75230-6856
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Country | US
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Telephone | 972-566-5872
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Fax | 972-566-6614
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Provider Business Mailing Address
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Address Line | 7777 FOREST LN C614
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-566-5872
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Fax | 972-566-6614
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALISON L LAIDLEY
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Credential | M.D.
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Telephone | 972-566-5872
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J2651
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License Number State | TX
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