# GENECOV PLASTIC SURGERY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Craniofacial Imaging
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417021247
- **Authorized official:** DAVID G GENECOV M.D. (PHYSICIAN)
- **Authorized official phone:** (972) 566-6555

## Contact information

- **Practice address:** 7777 FOREST LN, SUITE B312, DALLAS, TX 75230-2505
- **Practice address phone:** (972) 566-6555
- **Practice address fax:** (972) 566-6017
- **Mailing address:** 7777 FOREST LN, SUITE C717, DALLAS, TX 75230-2505
- **Mailing address phone:** (972) 566-6555
- **Mailing address fax:** (972) 566-6017

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | NA | TX | Yes |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 08/22/2020