Provider Demographics
NPI:1043873326
Name:PEDIATRIC NEUROLOGY OF DALLAS
Entity Type:Organization
Organization Name:PEDIATRIC NEUROLOGY OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAHSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-707-8121
Mailing Address - Street 1:7777 FOREST LANE
Mailing Address - Street 2:MEDICAL CITY DALLAS SUITE B-248
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2507
Mailing Address - Country:US
Mailing Address - Phone:972-566-8600
Mailing Address - Fax:972-566-8601
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:MEDICAL CITY DALLAS SUITE A-234
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2507
Practice Address - Country:US
Practice Address - Phone:972-566-5656
Practice Address - Fax:972-566-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty