Provider Demographics
NPI:1598548257
Name:WARTHAN DERMATOLOGY DALLAS LLC
Entity Type:Organization
Organization Name:WARTHAN DERMATOLOGY DALLAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-923-8220
Mailing Address - Street 1:5751 EDWARDS RANCH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4131
Mailing Address - Country:US
Mailing Address - Phone:817-923-8220
Mailing Address - Fax:817-923-9004
Practice Address - Street 1:12222 COIT RD STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2302
Practice Address - Country:US
Practice Address - Phone:817-923-8220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073773867OtherNPI
TX1740712363OtherNPI