Provider Demographics
NPI:1992445225
Name:DORN, TRISTAN GRACE
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:GRACE
Last Name:DORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 STONE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-3919
Mailing Address - Country:US
Mailing Address - Phone:972-693-3501
Mailing Address - Fax:
Practice Address - Street 1:8100 STONE RIDGE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75025-3919
Practice Address - Country:US
Practice Address - Phone:972-693-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program