Organization · NPI-2

Addison Total Wellness Clinic, PLLC

Family Medicine, Adult Medicine · Dallas, TX

NPI number1043715303
StatusActive
Last updated in NPPESMar 28, 2018

Details

NPI
1043715303
Entity type
Organization (NPI-2)
Legal business name
Addison Total Wellness Clinic, PLLC
Organization subpart
Yes
Enumeration date
Mar 28, 2018
Last updated
Mar 28, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207QA0505X Family Medicine, Adult Medicine––Yes
207Q00000X Family Medicine––

Practice location

15340 Dallas Pkwy Ste 2400
Dallas, TX 75248-6459

Phone 800-246-5698

Mailing address

5000 Eldorado Pkwy Ste 150-153
Frisco, TX 75033-8695

Authorized official

Salvatore Campo
DO/Physician
2147145343

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