Provider Demographics
NPI:1073575080
Name:DALLAS ENT & ALLERGY CENTER P A
Entity Type:Organization
Organization Name:DALLAS ENT & ALLERGY CENTER P A
Other - Org Name:DALLAS ENT & ALLERGY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:TIKOO
Authorized Official - Last Name:PANDIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-946-3687
Mailing Address - Street 1:1411 N BECKLEY AVE
Mailing Address - Street 2:PAV 3 SUITE 363
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1259
Mailing Address - Country:US
Mailing Address - Phone:214-946-3687
Mailing Address - Fax:214-946-0687
Practice Address - Street 1:1411 N BECKLEY AVE
Practice Address - Street 2:PAV 3 SUITE 363
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1259
Practice Address - Country:US
Practice Address - Phone:214-946-3687
Practice Address - Fax:214-946-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLI686207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH45185Medicare UPIN
TX8A7264Medicare ID - Type Unspecified