Provider Demographics
NPI:1740223429
Name:BENT TREE SURGERY CENTER
Entity Type:Organization
Organization Name:BENT TREE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-380-7090
Mailing Address - Street 1:17110 DALLAS PKWY
Mailing Address - Street 2:100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17110 DALLAS PKWY
Practice Address - Street 2:100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1167
Practice Address - Country:US
Practice Address - Phone:972-380-7090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical