Provider Demographics
NPI:1144418690
Name:DALLAS EAR, NOSE & THROAT CENTER PA
Entity Type:Organization
Organization Name:DALLAS EAR, NOSE & THROAT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-821-1809
Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 560
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0806
Mailing Address - Country:US
Mailing Address - Phone:214-821-1809
Mailing Address - Fax:214-827-9037
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 560
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-821-1809
Practice Address - Fax:214-827-9037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1440207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011DUOtherBLUE CROSS BLUE SHIELD
TX080401501Medicaid
TX00341NMedicare PIN