Provider Demographics
NPI:1043336860
Name:NORTH DALLAS ENT GROUP
Entity type:Organization
Organization Name:NORTH DALLAS ENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BANNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-566-4071
Mailing Address - Street 1:7777 FOREST LANE
Mailing Address - Street 2:SUITE B432
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2576
Mailing Address - Country:US
Mailing Address - Phone:972-566-8300
Mailing Address - Fax:972-566-8004
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE B432
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2576
Practice Address - Country:US
Practice Address - Phone:972-566-8300
Practice Address - Fax:972-566-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077HROtherTRONE BCTX
TX110688201Medicaid
TX0063PMOtherBLUE CROSS OF TEXAS
TX110688201Medicaid
TX00637ZMedicare PIN