Organization
STONEBRIDGE FIRST ASSIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE NICKSON M.D. (MANAGER)
(972) 547-0047
Entity
Organization
Contact information
Practice address
8865 SYNERGY DR, #101, MCKINNEY, TX 75070-6506
(972) 547-0047
(972) 547-0065
Mailing address
8865 SYNERGY DR, #101, MCKINNEY, TX 75070-6506
(972) 547-0047
(972) 547-0065
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
08/01/2013
Last updated
08/01/2013
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