Provider Demographics
NPI:1992868426
Name:DERMATOLOGY CENTER OF PLANO
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER OF PLANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-985-9003
Mailing Address - Street 1:5509 PLEASANT VALLEY DR
Mailing Address - Street 2:STE. 60
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5248
Mailing Address - Country:US
Mailing Address - Phone:972-985-9003
Mailing Address - Fax:972-985-1176
Practice Address - Street 1:5509 PLEASANT VALLEY DR
Practice Address - Street 2:STE. 60
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5248
Practice Address - Country:US
Practice Address - Phone:972-985-9003
Practice Address - Fax:972-985-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9311207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00987YMedicare ID - Type Unspecified