Provider Demographics
NPI:1871017913
Name:DALLAS PLASTIC SURGERY INSTITUTE MANAGEMENT, PA
Entity Type:Organization
Organization Name:DALLAS PLASTIC SURGERY INSTITUTE MANAGEMENT, PA
Other - Org Name:DPSIM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-823-5023
Mailing Address - Street 1:9101 N CENTRAL EXPY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-5956
Mailing Address - Country:US
Mailing Address - Phone:214-823-5023
Mailing Address - Fax:214-887-1897
Practice Address - Street 1:9101 N CENTRAL EXPY STE 600
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-5956
Practice Address - Country:US
Practice Address - Phone:214-823-5023
Practice Address - Fax:214-887-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty