Provider Demographics
NPI:1912935560
Name:NORTH DALLAS SURGICAL SPECIALISTS, PA
Entity Type:Organization
Organization Name:NORTH DALLAS SURGICAL SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:VACENDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-487-6400
Mailing Address - Street 1:3600 SHIRE BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2236
Mailing Address - Country:US
Mailing Address - Phone:972-487-6400
Mailing Address - Fax:972-487-1686
Practice Address - Street 1:3600 SHIRE BLVD STE 104
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2236
Practice Address - Country:US
Practice Address - Phone:972-487-6400
Practice Address - Fax:972-487-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080799202Medicaid
TX0056BYMedicare ID - Type UnspecifiedMEDICARE NUMBER