Provider Demographics
NPI:1083023303
Name:STEPHANIE K. TEOTIA MD PA
Entity Type:Organization
Organization Name:STEPHANIE K. TEOTIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:TEOTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-823-9652
Mailing Address - Street 1:4231 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2691
Mailing Address - Country:US
Mailing Address - Phone:214-823-9652
Mailing Address - Fax:214-823-4935
Practice Address - Street 1:4231 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2691
Practice Address - Country:US
Practice Address - Phone:214-823-9652
Practice Address - Fax:214-823-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP21942086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty