Provider Demographics
NPI:1629265558
Name:DALLAS NEUROSCIENCE, P.A.
Entity Type:Organization
Organization Name:DALLAS NEUROSCIENCE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-941-7655
Mailing Address - Street 1:1001 ROBBIE MINCE WAY STE C
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2012
Mailing Address - Country:US
Mailing Address - Phone:214-941-7655
Mailing Address - Fax:214-941-7626
Practice Address - Street 1:1001 ROBBIE MINCE WAY STE C
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2012
Practice Address - Country:US
Practice Address - Phone:214-941-7655
Practice Address - Fax:214-941-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192232001Medicaid
TXDH0010Medicare PIN
TX00Y494Medicare PIN