Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | K2643 | TX |
NPI | 1417918947 |
---|---|
Provider Name | Dr. Benjamin A Bassichis |
First Address | Dallas, TX 75254-6815 |
Second Address | Dallas, TX 75254-6815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H73339 | (02) | TX |