Provider Demographics
NPI:1033397062
Name:DFW SURGICAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:DFW SURGICAL SOLUTIONS LLC
Other - Org Name:DFW SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:817-480-1800
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76099-0186
Mailing Address - Country:US
Mailing Address - Phone:817-480-1800
Mailing Address - Fax:817-251-0205
Practice Address - Street 1:2521 LONE STAR LN
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-4535
Practice Address - Country:US
Practice Address - Phone:817-480-1800
Practice Address - Fax:817-251-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX537082/686090364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-SurgicalGroup - Single Specialty