Healthcare Provider Details

I. General information

NPI: 1093865487
Provider Name (Legal Business Name): BENJAMIN SANDERS MEYRAT DDS,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3606 MD LOVE FWY
DALLAS TX
75224-4442
US

IV. Provider business mailing address

1505 BOUNDBROOK LN
IRVING TX
75060-5552
US

V. Phone/Fax

Practice location:
  • Phone: 214-371-4763
  • Fax:
Mailing address:
  • Phone: 828-485-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19344
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: