Provider Demographics
NPI:1538751243
Name:DICKERSON DALLAS PAIN ON PA
Entity type:Organization
Organization Name:DICKERSON DALLAS PAIN ON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-850-9179
Mailing Address - Street 1:1675 REPUBLIC PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6902
Mailing Address - Country:US
Mailing Address - Phone:972-850-9179
Mailing Address - Fax:877-720-5614
Practice Address - Street 1:1675 REPUBLIC PKWY STE 201
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6902
Practice Address - Country:US
Practice Address - Phone:972-850-9179
Practice Address - Fax:877-720-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty