Provider Demographics
NPI:1982808218
Name:DALLAS-FORT WORTH FERTILITY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:DALLAS-FORT WORTH FERTILITY ASSOCIATES, P.A.
Other - Org Name:DFW FERTILITY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHANTILIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-363-5965
Mailing Address - Street 1:5477 GLEN LAKES DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0946
Mailing Address - Country:US
Mailing Address - Phone:214-363-5965
Mailing Address - Fax:214-363-0639
Practice Address - Street 1:5477 GLEN LAKES DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0946
Practice Address - Country:US
Practice Address - Phone:214-363-5965
Practice Address - Fax:214-363-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty