Organization
GENECOV PLASTIC SURGERY GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULI SMIDDY (PRACTICE ADMINISTRATOR)
(972) 331-1900
Entity
Organization
Contact information
Practice address
7777 FOREST LN STE C528, DALLAS, TX 75230-6848
(972) 331-1900
(972) 331-1909
Mailing address
7777 FOREST LN STE C528, DALLAS, TX 75230-6848
(972) 331-1900
(972) 331-1909
Taxonomy
Speciality
Code
Description
License number
State
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
NA
TX
235Z00000X
Speech-Language Pathologist
19138
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112848004
—
TX
01
—
TXB102342
MEDICARE PTAN
—
Enumeration date
03/26/2007
Last updated
04/16/2021
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