Provider Demographics
NPI:1417198854
Name:DALLAS ENT AND ALLERGY CENTER
Entity Type:Organization
Organization Name:DALLAS ENT AND ALLERGY CENTER
Other - Org Name:DALLAS ENT HEAD AND NECK SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-946-3687
Mailing Address - Street 1:221 W COLORADO BLVD
Mailing Address - Street 2:PAV II SUITE 943
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2363
Mailing Address - Country:US
Mailing Address - Phone:214-946-3687
Mailing Address - Fax:214-946-0687
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:PAV II SUITE 943
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-946-3687
Practice Address - Fax:214-946-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty