Provider Demographics
NPI:1790005734
Name:NORTH DALLAS MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:NORTH DALLAS MEDICAL GROUP, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZENIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-233-3094
Mailing Address - Street 1:7224 CANONGATE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:241-244-6171
Mailing Address - Fax:972-733-0991
Practice Address - Street 1:16901 DALLAS PKWY STE 206
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5214
Practice Address - Country:US
Practice Address - Phone:214-233-3094
Practice Address - Fax:214-241-1167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA02353OtherTEXAS MEDICAL BOARD