Provider Demographics
NPI:1417313222
Name:PLASTIC SURGERY OF TEXAS
Entity Type:Organization
Organization Name:PLASTIC SURGERY OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-905-5075
Mailing Address - Street 1:10743 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3806
Mailing Address - Country:US
Mailing Address - Phone:214-905-5075
Mailing Address - Fax:214-905-0903
Practice Address - Street 1:10743 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3806
Practice Address - Country:US
Practice Address - Phone:214-905-5075
Practice Address - Fax:214-905-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7235305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization