Provider Demographics
NPI:1225002538
Name:PLASTIC AND CRANIOFACIAL SURGERY FOR INFANTS AND CHILDREN, P.A.
Entity Type:Organization
Organization Name:PLASTIC AND CRANIOFACIAL SURGERY FOR INFANTS AND CHILDREN, P.A.
Other - Org Name:PLASTIC AND CRANIOFACIAL SURGERY FOR INFANTS AND CHILDREN, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-456-8834
Mailing Address - Street 1:PO BOX 35046
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0046
Mailing Address - Country:US
Mailing Address - Phone:214-456-8834
Mailing Address - Fax:214-456-6843
Practice Address - Street 1:6300 HARRY HINES BLVD
Practice Address - Street 2:#600
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5259
Practice Address - Country:US
Practice Address - Phone:214-456-8834
Practice Address - Fax:214-456-6843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000006FMedicare PIN