Provider Demographics
NPI:1194077099
Name:DRESS RECONSTRUCTIVE SURGERY, P.A.
Entity type:Organization
Organization Name:DRESS RECONSTRUCTIVE SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PLASTIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-362-6191
Mailing Address - Street 1:11 RACETRACK RD NE
Mailing Address - Street 2:STE. E4
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1882
Mailing Address - Country:US
Mailing Address - Phone:850-200-4575
Mailing Address - Fax:850-200-4576
Practice Address - Street 1:11 RACETRACK RD NE
Practice Address - Street 2:STE. E4
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1882
Practice Address - Country:US
Practice Address - Phone:850-200-4575
Practice Address - Fax:850-200-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87448208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty