Provider Demographics
NPI:1386228930
Name:UNITED DERMATOLOGY ASSOCIATES OF ARLINGTON, PLLC
Entity Type:Organization
Organization Name:UNITED DERMATOLOGY ASSOCIATES OF ARLINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-261-1122
Mailing Address - Street 1:130 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5167
Mailing Address - Country:US
Mailing Address - Phone:817-261-1122
Mailing Address - Fax:817-207-4189
Practice Address - Street 1:3132 MATLOCK RD STE 307
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2922
Practice Address - Country:US
Practice Address - Phone:817-539-0959
Practice Address - Fax:817-207-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty