Provider Demographics
NPI:1134427206
Name:TEXAS DERMATOLOGY AND SKIN CANCER CENTER, PLLC
Entity type:Organization
Organization Name:TEXAS DERMATOLOGY AND SKIN CANCER CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAMBRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-757-4410
Mailing Address - Street 1:3142 HORIZON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7809
Mailing Address - Country:US
Mailing Address - Phone:469-757-4410
Mailing Address - Fax:469-277-3911
Practice Address - Street 1:3142 HORIZON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7809
Practice Address - Country:US
Practice Address - Phone:469-757-4410
Practice Address - Fax:469-277-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7906207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty