Provider Demographics
NPI:1326692468
Name:WESTLAKE DERMATOLOGY, PA
Entity Type:Organization
Organization Name:WESTLAKE DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIKOLAIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-328-3376
Mailing Address - Street 1:8825 BEE CAVES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4721
Mailing Address - Country:US
Mailing Address - Phone:512-328-3376
Mailing Address - Fax:512-666-3767
Practice Address - Street 1:7515 GREENVILLE AVE STE 1030
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3866
Practice Address - Country:US
Practice Address - Phone:972-512-4800
Practice Address - Fax:214-484-9994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty