=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790005734
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH DALLAS MEDICAL GROUP, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2010
-----------------------------------------------------
Last Update Date | 05/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16901 DALLAS PKWY STE 206
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-5214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-233-3094
-----------------------------------------------------
Fax | 214-241-1167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7224 CANONGATE DR
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 241-244-6171
-----------------------------------------------------
Fax | 972-733-0991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. ZENIA C ORTEGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-233-3094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------