Provider Demographics
NPI:1447774997
Name:DEHESHI, BENJAMIN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:DEHESHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 E SOUTHLAKE BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6464
Mailing Address - Country:US
Mailing Address - Phone:817-332-7867
Mailing Address - Fax:817-332-7861
Practice Address - Street 1:1545 E SOUTHLAKE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6464
Practice Address - Country:US
Practice Address - Phone:817-332-7867
Practice Address - Fax:817-332-7861
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3309207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery