Provider Demographics
NPI:1932555133
Name:DALLAS PEDIATRICS AND CHILDREN'S HEALTHCARE, P.A.
Entity Type:Organization
Organization Name:DALLAS PEDIATRICS AND CHILDREN'S HEALTHCARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-728-8867
Mailing Address - Street 1:3409 SPECTRUM BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-9713
Mailing Address - Country:US
Mailing Address - Phone:214-728-8867
Mailing Address - Fax:972-231-0360
Practice Address - Street 1:12606 GREENVILLE AVE STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1926
Practice Address - Country:US
Practice Address - Phone:214-292-0072
Practice Address - Fax:972-231-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX359470704Medicaid
TX046074305Medicaid
TX046074304Medicaid
TX046074306Medicaid
TX359470702Medicaid