Organization
LASER VAGINAL REJUVENATION INSTITUTE OF DALLAS PA
Active
Other names
WOMENS WELLNESS INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMIE M JACKSON (BILLING MGR)
(469) 916-4767
Entity
Organization
Contact information
Practice address
9101 N CENTRAL EXPY, SUITE 550, DALLAS, TX 75231-5927
(214) 442-0055
(214) 442-0056
Mailing address
9101 N CENTRAL EXPY, SUITE 550, DALLAS, TX 75231-5927
(214) 442-0055
(214) 442-0056
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
K8880
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0097PK
BCBS
TX
Enumeration date
06/26/2008
Last updated
06/26/2008
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