Provider Demographics
NPI:1376917633
Name:DILWORTH FACIAL PLASTIC SURGERY, PLLC
Entity Type:Organization
Organization Name:DILWORTH FACIAL PLASTIC SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SUROWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-619-0383
Mailing Address - Street 1:1819 LYNDHURST AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5103
Mailing Address - Country:US
Mailing Address - Phone:980-949-6544
Mailing Address - Fax:980-422-0091
Practice Address - Street 1:1819 LYNDHURST AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5103
Practice Address - Country:US
Practice Address - Phone:980-949-6544
Practice Address - Fax:980-422-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-00940207Y00000X, 207YS0123X, 207YX0007X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty