Provider Demographics
NPI:1396500476
Name:DYSON DERMATOLOGY PLLC
Entity type:Organization
Organization Name:DYSON DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-838-0777
Mailing Address - Street 1:2222 N CRAYCROFT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2830
Mailing Address - Country:US
Mailing Address - Phone:520-838-0777
Mailing Address - Fax:520-838-0669
Practice Address - Street 1:516 E WHITEHOUSE CANYON RD STE 100
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0542
Practice Address - Country:US
Practice Address - Phone:520-625-0800
Practice Address - Fax:520-625-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty