Organization Active NPI

Marquis Center of Dallas PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • Dallas, TX
National Provider Identifier
1124917836
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
MARQUIS CENTER OF DALLAS PLLC
Practice address
8215 Westchester Dr Ste 112
Dallas, TX 75225-6109
Phone
(618) 402-6622
NPI assigned
Jun 30, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Clark Petersen
Title
Director of Infrastructure
Phone
(618) 402-6622

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X Primary

Addresses

Primary practice location

8215 Westchester Dr Ste 112
Dallas, TX 75225-6109

Mailing address

4447 N Central Expy Ste 110
Dallas, TX 75205-4246
Phone (618) 402-6622

National Provider Directory

National Provider Directory

Locations

8215 Westchester Dr
Ste 112
Dallas, TX 75225
Phone (469) 663-8921

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751241600000",
    "number": "1124917836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4447 N CENTRAL EXPY STE 110",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752054246",
            "telephone_number": "618-402-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8215 WESTCHESTER DR STE 112",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752256109",
            "telephone_number": "618-402-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARQUIS CENTER OF DALLAS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-30",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "CLARK",
        "authorized_official_title_or_position": "DIRECTOR OF INFRASTRUCTURE",
        "authorized_official_telephone_number": "618-402-6622",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.