Provider Demographics
NPI:1477783330
Name:NORTH DALLAS PLASTIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:NORTH DALLAS PLASTIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-509-0270
Mailing Address - Street 1:8305 WALNUT HILL LN
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4217
Mailing Address - Country:US
Mailing Address - Phone:214-509-0270
Mailing Address - Fax:214-363-3665
Practice Address - Street 1:1105 CENTRAL EXPWY N
Practice Address - Street 2:SUITE 2310
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6115
Practice Address - Country:US
Practice Address - Phone:214-363-2575
Practice Address - Fax:214-363-3665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH DALLAS PLASTIC SURGERY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85731FMedicare PIN
TXG80542Medicare UPIN