Provider Demographics
NPI:1255615258
Name:UNIVERSITY OF DALLAS
Entity type:Organization
Organization Name:UNIVERSITY OF DALLAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURETTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEKET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-721-5322
Mailing Address - Street 1:1845 E NORTHGATE DR
Mailing Address - Street 2:HAGGAR BLDG 2ND FLOOR
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-4736
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1845 E NORTHGATE DR
Practice Address - Street 2:HAGGAR BLDG 2ND FLOOR
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4736
Practice Address - Country:US
Practice Address - Phone:972-721-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-09
Last Update Date:2011-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health