Provider Demographics
NPI:1982069399
Name:DALLAS CENTER FOR DERMATOLOGY AND AESTHETICS PLLC
Entity Type:Organization
Organization Name:DALLAS CENTER FOR DERMATOLOGY AND AESTHETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:D
Authorized Official - Last Name:STETLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-631-7546
Mailing Address - Street 1:8201 PRESTON RD
Mailing Address - Street 2:STE 350
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6203
Mailing Address - Country:US
Mailing Address - Phone:214-631-7546
Mailing Address - Fax:214-631-8546
Practice Address - Street 1:8201 PRESTON RD
Practice Address - Street 2:STE 350
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225
Practice Address - Country:US
Practice Address - Phone:214-631-7546
Practice Address - Fax:214-631-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty