Organization
CLINIQUE DALLAS PLASTIC SURGERY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN WILLIAM ANTONETTI (CEO/SURGEON)
(972) 566-2010
Entity
Organization
Contact information
Practice address
7777 FOREST LN STE C212, DALLAS, TX 75230-6836
(972) 566-2010
(855) 592-2934
Mailing address
7777 FOREST LN STE C212, DALLAS, TX 75230-6836
(972) 566-2010
(855) 592-2934
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2931776-01
—
TX
Enumeration date
05/14/2009
Last updated
09/23/2025
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