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General NPI Number Information
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NPI Number | 1053855882
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Entity Type | Organization
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Legal Business Name | ANASTASIA BENSON, DO PA
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Dates
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Enumeration Date | 12/13/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 6301 GASTON AVE SUITE 445
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City | DALLAS
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State | TX
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Zip | 75214-3922
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Country | US
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Telephone | 214-810-3553
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Fax | 844-823-2616
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Provider Business Mailing Address
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Address Line | 6301 GASTON AVE SUITE 445
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City | DALLAS
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State | TX
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Zip | 75214-3922
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Country | US
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Telephone | 214-810-3553
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Fax | 844-823-2616
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANASTASIA BENSON
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Credential | D.O.
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Telephone | 214-810-3553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | Q0005
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License Number State | TX
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