Provider Demographics
NPI:1497031413
Name:CENTRAL PARK EAR NOSE AND THROAT LLP DALLAS
Entity Type:Organization
Organization Name:CENTRAL PARK EAR NOSE AND THROAT LLP DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-261-9191
Mailing Address - Street 1:409 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2069
Mailing Address - Country:US
Mailing Address - Phone:817-261-9191
Mailing Address - Fax:817-784-6880
Practice Address - Street 1:3131 TURTLE CREEK BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-5405
Practice Address - Country:US
Practice Address - Phone:972-884-5606
Practice Address - Fax:972-884-5607
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL PARK EAR NOSE AND THROAT LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-24
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty