Provider Demographics
NPI:1376921734
Name:TRINITY PLASTIC SURGERY PLLC
Entity Type:Organization
Organization Name:TRINITY PLASTIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRANSACTION POSTER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-396-3936
Mailing Address - Street 1:PO BOX 674074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4074
Mailing Address - Country:US
Mailing Address - Phone:214-396-3936
Mailing Address - Fax:214-378-4664
Practice Address - Street 1:221 W COLORADO BLVD STE 441
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2312
Practice Address - Country:US
Practice Address - Phone:214-396-3936
Practice Address - Fax:214-378-4664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty