Provider Demographics
NPI:1770727844
Name:DERMATOLOGY CARE CENTER
Entity type:Organization
Organization Name:DERMATOLOGY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOBOLAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:OPEOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:214-432-4387
Mailing Address - Street 1:17194 PRESTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1221
Mailing Address - Country:US
Mailing Address - Phone:214-432-4387
Mailing Address - Fax:866-886-2083
Practice Address - Street 1:7712 SAN JACINTO PL
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3257
Practice Address - Country:US
Practice Address - Phone:214-432-4387
Practice Address - Fax:866-886-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty