Provider Demographics
NPI:1205198074
Name:DALLAS RESTORATION SERVICES
Entity type:Organization
Organization Name:DALLAS RESTORATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DALLAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:405-677-2767
Mailing Address - Street 1:920 S BOULEVARD STE 103
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4731
Mailing Address - Country:US
Mailing Address - Phone:405-406-4803
Mailing Address - Fax:
Practice Address - Street 1:920 S BOULEVARD STE 103
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-4731
Practice Address - Country:US
Practice Address - Phone:405-406-4803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health