Provider Demographics
NPI:1093205965
Name:DINA ITUM, MD, PLLC
Entity Type:Organization
Organization Name:DINA ITUM, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ITUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-913-4522
Mailing Address - Street 1:7777 FOREST LN STE A331
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2538
Mailing Address - Country:US
Mailing Address - Phone:972-566-7860
Mailing Address - Fax:972-566-6673
Practice Address - Street 1:7777 FOREST LN STE A331
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2538
Practice Address - Country:US
Practice Address - Phone:972-566-7860
Practice Address - Fax:972-566-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty