Organization
COSMETIC SURGERY OF DFW PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUSTIN DERRICK MD (OWNER)
(817) 529-4314
Entity
Organization
Contact information
Practice address
800 12TH AVE STE 100, FORT WORTH, TX 76104-2519
(817) 529-4314
(844) 210-1095
Mailing address
800 12TH AVE STE 100, FORT WORTH, TX 76104-2519
(817) 529-4314
(844) 210-1095
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
04/28/2021
Last updated
04/28/2021
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