# LASER VAGINAL REJUVENATION INSTITUTE OF DALLAS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WOMENS WELLNESS INSTITUTE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932361441
- **Authorized official:** TAMMIE M JACKSON (BILLING MGR)
- **Authorized official phone:** (469) 916-4767

## Contact information

- **Practice address:** 9101 N CENTRAL EXPY, SUITE 550, DALLAS, TX 75231-5927
- **Practice address phone:** (214) 442-0055
- **Practice address fax:** (214) 442-0056
- **Mailing address:** 9101 N CENTRAL EXPY, SUITE 550, DALLAS, TX 75231-5927
- **Mailing address phone:** (214) 442-0055
- **Mailing address fax:** (214) 442-0056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | K8880 | TX | Yes |

## Other

- **Enumeration date:** 06/26/2008
- **Last updated:** 06/26/2008