Provider Demographics
NPI:1790005734
Name:NORTH DALLAS MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:NORTH DALLAS MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:ORTEGA , PAC
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:214-244-6171
Mailing Address - Street 1:7224 CANONGATE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:241-244-6171
Mailing Address - Fax:972-733-0991
Practice Address - Street 1:7901 JOHN CARPENTER FRWY SUITE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4832
Practice Address - Country:US
Practice Address - Phone:469-578-8240
Practice Address - Fax:469-533-5867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty