Essential Dermatology and Cosmetic Surgery PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

ESSENTIAL DERMATOLOGY AND COSMETIC SURGERY PLLC

Practice address

1105 Santa Fe Drive
Ste 105
Weatherford, TX 76086-5852

Phone

(806) 241-4195

NPI assigned

Jan 30, 2015

Last updated

Mar 28, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dustin Van Wilkes, D.O.

Title

Owner/Ceo

Phone

(806) 241-4195

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427500800000",
    "number": "1962892737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SANTA FE DRIVE",
            "address_2": "STE 105",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760865852",
            "telephone_number": "806-241-4195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SANTA FE DRIVE",
            "address_2": "STE 105",
            "city": "WEATHERFORD",
            "state": "TX",
            "postal_code": "760865852",
            "telephone_number": "806-241-4195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIAL DERMATOLOGY AND COSMETIC SURGERY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-03-28",
        "status": "A",
        "authorized_official_last_name": "WILKES",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_middle_name": "VAN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "806-241-4195",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Weatherford, TX
• Providers in Weatherford, TX by specialty
• Medical Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2015; 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.