Provider Demographics
NPI:1710072814
Name:DAKOTA MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:DAKOTA MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-429-4553
Mailing Address - Street 1:791 S HWY 78
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4004
Mailing Address - Country:US
Mailing Address - Phone:972-429-4553
Mailing Address - Fax:972-429-4233
Practice Address - Street 1:791 S HWY 78
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-429-4553
Practice Address - Fax:972-429-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8766M0Medicare PIN
TXA65327Medicare UPIN