Basic Information
| Provider Information | |||||||||
| NPI: | 1588233738 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DALLAS PAIN AND SPINE INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 497319 | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750497319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729991659 | ||||||||
| FaxNumber: | 2057295887 | ||||||||
| Practice Location | |||||||||
| Address1: | 3453 SAINT FRANCIS AVE STE 125 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752286098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729991659 | ||||||||
| FaxNumber: | 2057295887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2021 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | ABDELFATTAH | ||||||||
| AuthorizedOfficialFirstName: | BASEM | ||||||||
| AuthorizedOfficialMiddleName: | AHEMED | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9152410997 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.