Organization
NTKC-DFW, PLLC
Active
Other names
North Texas Kidney Consultants
Organization subpart
No
Provider details
NPI number
Authorized official
DAN BACCUS (CFO)
(817) 488-6669
Entity
Organization
Contact information
Practice address
2425 HIGHWAY 121 STE 201, BEDFORD, TX 76021-5011
(817) 283-5166
(817) 283-5176
Mailing address
3801 WILLIAM D TATE AVE STE 105, GRAPEVINE, TX 76051-8755
(817) 488-6812
(817) 251-1303
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209283502
—
TX
Enumeration date
10/05/2009
Last updated
04/08/2022
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